Glycemic control and cardiovascular complications of type 2 diabetes mellitus

Abstract

Over the past few decades, the prevalence of diabetes in developed and developing countries has increased dramatically, making diabetes a key health priority worldwide. It can be assumed that an increase in the life expectancy of patients with diabetes significantly affects the prevalence of diabetes, maintaining the trend of its increase. Patients with type 2 diabetes mellitus (DM2) are at higher risk for cardiovascular disease and its adverse outcomes compared to the general population. The pathophysiological relationship between hyperglycemia and cardiovascular disease is beyond doubt. Glycemic control per se remains essential for the successful management of diabetes, prevention of chronic complications of the disease and death. Diabetes control involves, first of all, the achievement of target indicators of carbohydrate metabolism. The use of glycated hemoglobin (HbA1c), despite known sensitivity limitations, has become the standard for assessing glycemic control in diabetic patients. Early achievement of the target HbA1c level reduces the risk of diabetic complications, increases the likelihood of long-term sustainable disease control. Numerous clinical studies have demonstrated that higher HbA1c and greater HbA1c variability are manageable risk factors for adverse cardiovascular events. Optimal hypoglycemic therapy for diabetes in order to reduce cardiovascular risks should ensure the achievement of the target level of glycemic control as soon as possible (the first 3 months of therapy), maintaining the target level of glycemia with the lowest possible HbA1c variability in subsequent years and therapy should be safe. Timely intensification of therapy, including the use of insulin, can prevent the negative consequences of prolonged hyperglycemia. Glar-100 has a high efficacy and safety in comparison with other insulin preparations at the initiation and intensification of DM2 therapy. RingGlar® and Lantus® are equivalent drugs.