Antihyperglycaemic treatment and vascular diseases

Czech version

Authors: Š. Svačina
Authors‘ workplace: III. interní klinika 1. lékařské fakulty UK a VFN Praha, přednosta prof. MU Dr. Štěpán Svačina, DrSc., MBA
Published in: Vnitř Lék 2010; 56(4): 313-316
Category: 11th National Diabetes Symposium "Diabetes and Angiology", Hradec Kralove, 5 to 6 June 2009

Overview

Hyperglycaemia is being linked to the development of vascular complications of diabetes – diabetic micro‑ as well as macro‑angiopathies. It is, therefore, logical to assume that a reduction of glycaemia will result in a reduction of diabetic complications. However, recent clinical studies in type 2 diabetes described a range of observations that make this general statement less unambiguous: possibly increased incidence of coronary events following rosiglitazone use, discontinuation of some studies due to significantly decreased HbA_1c in long‑term diabetes, metabolic memory phenomenon, where early diabetes treatment exerts it effect for more than 10 years, and resulting differences in treatment approach to type 2 diabetes patients with respect to the duration of the disease. It can be concluded with respect to the issue of antihypeglycaemia treatment and its cardiovascular effect: 1. Early compensation of diabetes in newly diagnosed diabetic patients exerts its effect as long as 15 years and more. 2. Longer duration of diabetes implicates probably higher target value for diabetes compensation than the current 5.3% HbA_1c according to IFCC. 3. No link has been proven between a specific anti‑diabetic agent and worsened cardiovascular prognosis; the RECORD study provided conclusive evidence that rosiglitazone has no negative effect on the vascular system. 4. On contrary, it is very likely that some of the new anti‑diabetic agents, for example from among the incretin analogues, will impact positively on the vascular system. 5. There is no doubt about the importance of hyperglycaemia correction in prevention of cardiovascular diseases in type 1 diabetes patients.

Key words:
diabetes mellitus – anti‑diabetic agents – cardiovascular complication of diabetes – metformin – glitazones – incretin analogues – metabolic memory

Sources

1. Šmahelová A. Konservativní léčba diabetické mikroangiopatie a makroangiopatie. Čas Lék Česk 2009; 148: 72– 75.

2. Holman RR, Watkins PJ. UKPDS – the first 30 years. Oxford: Wiley Blackwell 2008.

3. Svačina Š. Prevence diabetu a jeho komplikací. Praha: Triton 2008.

4. Holman RR, Paul SK, Bethel MA et al. 10‑year follow‑up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359: 1577– 1589.

5. Haluzík M, Svačina Š. Metabolický syndrom a nukleární receptory PPAR. Praha: Grada 2005.

6. Dormandy JA, Charbonnel B, Eckland DJ et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet 2005; 366: 1279– 1289.

7. Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 2007; 356: 2457– 2471.

8. Home PD, Jones NP, Pocock SJ et al. RECORD Study Group. Rosiglitazone RECORD study: glucose control outcomes at 18 months. Diabet Med 2007; 24: 626– 634.

9. Home PD, Pocock SJ, Beck‑ Nielsen H et al. Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open‑ label trial. Lancet 2009; 373: 2125– 2135.

10. Skyler JS, Bergenstal R, Bonow RO et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA Diabetes Trials: a position statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association. J Am Coll Cardiol 2009; 53: 298– 304.

11. Mazzone T, Meyer PM, Feinstein SB et al. Effect of pioglitazone compared with glimepiride on carotid intima‑ media thickness in type 2 diabetes: a randomized trial. JAMA 2006; 296: 2572– 2581.

12. Frye RL, August P, Brooks MM et al. BARI 2D Study Group. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med 2009; 360: 2503– 2515.

13. Kelly TN, Bazzano LA, Fonseca VA et al. Systematic review: glucose control and cardiovascular disease in type 2 diabetes. Ann Intern Med 2009; 151: 394– 403.

14. Genuth S. Insights from the diabetes control and complications trial/ epidemiology of diabetes interventions and complications study on the use of intensive glycemic treatment to reduce the risk of complications of type 1 diabetes. Endocr Pract 2006; 12 (Suppl 1): 34– 41.

15. Meier CC. Diabetes and the heart. Best Pract Res Clin Endocr Metab 2009; 23: 291– 411.