New Perspectives in Type 2 Diabetes, Cardiovascular Risk, and Treatment Goals

Abstract

Diabetes mellitus is a complex and increasingly common metabolic disease that is characterized by hyperglycemia and associated with microvascular and macrovascular complications. Approximately 90% of patients with diabetes have type 2 diabetes. Obesity and type 2 diabetes are intricately linked, with weight gain being a major contributor to the increasing incidence of type 2 diabetes. Both conditions are independent risk factors for cardiovascular disease, which is the cause of death for the majority (65%) of patients with diabetes. Data from recent large-scale outcomes trials continue to clarify the role of glucose-lowering therapy for patients with type 2 diabetes and increased risk of cardiovascular disease. This serves to further underscore the importance of an individualized treatment approach that takes duration of disease, presence of complications and comorbidities, and the potential adverse risks of therapy into consideration. Although the currently available antidiabetes medications are effective in lowering glucose, some of these agents, including insulin, sulfonylureas, and thiazolidinediones, are often limited by weight gain and/or hypoglycemia. Expert panel guidelines recommend a comprehensive approach that targets the traditional risk factors (glucose, weight, blood pressure, lipids) as the ideal treatment strategy to prevent complications of type 2 diabetes. Incretin-based therapies, including the glucagon-like peptide-1 receptor agonists, target the fundamental defects of type 2 diabetes, reduce glycosylated hemoglobin and body weight, and have potentially beneficial effects on blood pressure, lipids, and other surrogate markers, leading to reduced cardiovascular risk. Physicians should be encouraged to adopt a therapeutic approach with individualized patient goals. By reinforcing the role of patients with type 2 diabetes in treatment decisions, better compliance and achievement of treatment goals can be achieved.

The effect of the introduction of a standard monitoring protocol on the investigations performed on the metabolic control of type 2 diabetes at Addington Hospital Medical Outpatients Department, Durban, South Africa

“…Both are independent risk factors for the development of cardiovascular disease. 12 Difficulties in achieving weight loss may be partly cultural, and it has been shown that few overweight black women consider themselves overweight and that thinness is associated with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). 13 A Cape Town study of 240 black girls showed that two-thirds perceived fatness as a sign of happiness and wealth.…”

Insulin plus incretin: A glucose-lowering strategy for type 2-diabetes

“…Hypoglycemia is associated with negative impact, such as unpleasant and sometimes dangerous symptoms, weight gain (due to defense eating), deterioration of glycemic control (due to reduced adherence to therapy and therapeutic goals because of fear of new hypoglycemic episodes), increased cardiovascular risk and increased risk for microvascular complications [38][39][40][41] . Insulin therapy is associated with a high risk of hypoglycemia [29][30][31] .…”

Glucagon like peptide-1 receptor agonist (GLP-1RA) therapy in management of type 2 diabetes: choosing the right agent for individualised care

“…Although structured education and life-style modifications are the basic pillars in managing T2DM, achieving and maintaining glycaemic control becomes a challenge as the condition progresses despite the availability and use of multiple glucose lowering therapies. 2 Moreover, the conventional therapies used in the management of T2DM can be associated with undesirable side effects such as hypoglycaemia and weight gain. However, treatment with GLP1RAs has the added benefit of weight loss and a low risk of hypoglycaemia in addition to improving glycaemic control.…”

“…1 This includes reduced insulin secretion from β-cells, increased glucagon production from α-cells, increased hepatic glucose output, increased lipolysis, increased renal glucose reabsorption, insulin resistance (in the periphery, where it reduces glucose uptake, and in the brain, where it promotes greater food intake), neurotransmitter dysfunction, and a reduced incretin effect. 1,2 Incretins are gut hormones produced from intestinal cells in response to oral glucose ingestion, which in turn stimulates insulin secretion. In people without diabetes, an oral glucose load elicits a greater insulin response than intravenous glucose administration, known as the "incretin effect".…”