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Strategies for optimizing glycemic control and cardiovascular prognosis in patients with type 2 diabetes mellitus

James H O'Keefe1, Mohammad Abuannadi, Carl J Lavie

  • 1Mid America Heart and Vascular Institute and University of Missouri-Kansas City, Kansas City, MO, USA.

Mayo Clinic Proceedings
|January 29, 2011
PubMed

Insights

Type 2 diabetes increases cardiovascular risk. While glycemic control is important, certain therapies may offer additional cardiovascular benefits by targeting insulin resistance and hyperglycemia without causing hypoglycemia.

Area of Science:

  • Endocrinology
  • Cardiology
  • Pharmacology

Background:

  • Type 2 diabetes mellitus (DM) is a significant cardiovascular (CV) risk factor, often considered a coronary artery disease risk equivalent.
  • Despite epidemiological links between glycemic control and reduced CV events, clinical trials have not definitively proven aggressive control improves CV outcomes in type 2 DM, particularly in long-standing cases.

Purpose of the Study:

  • To review evidence on antidiabetic agents with potential CV benefits.
  • To discuss appropriate glycemic control targets for improving CV prognosis in type 2 DM patients.

Main Methods:

  • Systematic review of English-language articles.
  • Searched MEDLINE and Cochrane Controlled Trials Register (1970-2010).
  • Keywords included: cardiovascular disease, randomized trials, hypoglycemia, insulin resistance.

Main Results:

  • Some type 2 DM therapies possess glucose-lowering actions alongside properties that may influence CV events.
  • Agents addressing insulin resistance and postprandial hyperglycemia while avoiding hypoglycemia may benefit CV health.

Conclusions:

  • Therapeutic strategies for type 2 DM should consider agents that improve CV prognosis.
  • Optimizing glycemic control targets and agent selection is crucial for managing cardiovascular risk in type 2 DM.

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