Téma: Overview works

Present views of diabetes mellitus type 2 treatment

Emil Martinka

Abstract. In recent two years undoubtedly the most discussed theme in clinical diabetology has been the question if intensive glycaemic control (with practically normalization of glycaemia values) brings a benefit or vice versa increases morbidity and mortality risk. The recent post hoc analysis of the study ACCORD, which evaluates the risk not only according to chosen intensive or standard strategy but also to the average achieved value of HbA1c in both branches, showed that the best prognosis was achieved by the patients in the intensive branch who really reached intensive criteria. However, the worst prognosis is related to the intensive branch but the patients are those who did not fulfil the intensive criteria. The higher incidence of hypoglycaemia was also detected in this risk group (unlike the expectations) in another recent analysis. So the intensive glycaemic control improves morbidity and mortality prognosis in patients with Diabetes mellitus 2. treatment (DM 2), but it is necessary to start the control early and it should be achieved easily, i.e. without obstacles. If obstacles appear at intensification as frequent incidence of hypoglycaemia or excessive oscillations of hypoglycaemia, it is better to continue in standard treatment strategy with target Hba1c values cca 7-8 % (as optimum seems to be 7.5 %). Besides the questions of intensive glycaemic control, the overview pays attention to hypoglycaemia as a risk factor and at the same time a marker identifying patients with increased risk, to importance of extraglycaemic factors related to subclinical adipogenic and vascular inflammation and dysfunction of endothelium, to dysfunction of endocrine activity of adipose tissue as well as to questions of increased incidence of oncological diseases in patients with DM 2 and to present views of therapeutical approach to patients with DM 2.

Ročník 2010  Témy časopisu Internal medicine 10 / 2010

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prof. MUDr. Peter Mitro, PhD.
doc. MUDr. Viliam Mojto, CSc., MHA
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3. LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
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