Strategies for Optimizing Glycemic Control and Cardiovascular Prognosis in Patients With Type 2 Diabetes Mellitus

Contrast-Induced Nephropathy in Patients with Type 2 Diabetes Mellitus and Coronary Artery Disease: Update and Practical Clinical Applications

“…Observational studies suggest that hypoglycemia should be avoided (Zoungas et al, 2010). Guidelines now recommend a therapeutic target of glucose control at 140 to 180 mg/dL in the critically ill patient which is a more liberal approach than prior recommendations (O'Keefe et al, 2011). Previously recommended more aggressive glucose lowering (including normalization of blood sugar) was not shown to have additional benefit and appeared to be harmful because of the increased incidence of hypoglycemia.…”

Tip 2 Diabetes Mellituslu Hastalar Tarafından Başvurulan Hekim Sayısının Hedef Değerlere Ulaşma ve Tedaviye Uyum Oranları Üzerine Etkileri

“…Patients' adherence to treatment is influenced by many factors, all related to each other. Complexity of treatment, reasonable course of treatment and possible side effects play an important role in patients' adherence (23). Physicians and other healthcare professionals are faced with the hard task of treating diabetic patients with poor glycemic control.…”

Insulin Therapy and Hypoglycemia - Present and Future

“…Hypoglycemia, mainly the recurrent and severe episodes, and the presumed ensuing cardiovascular toxicity may increase the susceptibility to poor cardiovascular outcomes, especially in subjects with significant atherosclerosis and functional / structural heart abnormalities. The cause of excess mortality during intensive therapy seen in the ACCORD study is not entirely clear, but it is thought that the most plausible cause is iatrogenic hypoglycemia (51). Thus, it is equally important to avoid both hyperglycemic surges and hypoglycemic events while striving to obtain a tight metabolic control.…”

“…Moreover, the unpleasant symptoms and negative consequences of hypoglycemia may result in fear and anxiety, lower treatment satisfaction, which in turn may negatively impact the diabetes management and adherence to therapy, precluding a full attainment of the benefits offered by improved glycemic control (48). Evidence exist that hypoglycemic episodes, especially severe ones, are associated with adverse cardiovascular events (such as prolongation of the QT interval, cardiac arrhythmias, sudden cardiac arrest, and acute myocardial infarction), which are triggered by the stimulation of the sympathetic nervous system and the catecholamine surge (51,52). Hypoglycemia also has proinflammatory consequences that may augment the risk of plaque inflammation and rupture, causing subsequent cardiovascular events (51).…”

“…Evidence exist that hypoglycemic episodes, especially severe ones, are associated with adverse cardiovascular events (such as prolongation of the QT interval, cardiac arrhythmias, sudden cardiac arrest, and acute myocardial infarction), which are triggered by the stimulation of the sympathetic nervous system and the catecholamine surge (51,52). Hypoglycemia also has proinflammatory consequences that may augment the risk of plaque inflammation and rupture, causing subsequent cardiovascular events (51). Hypoglycemia, mainly the recurrent and severe episodes, and the presumed ensuing cardiovascular toxicity may increase the susceptibility to poor cardiovascular outcomes, especially in subjects with significant atherosclerosis and functional / structural heart abnormalities.…”