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Glucose control and cardiovascular outcomes: reorienting approach
Romesh Khardori1, Diep D Nguyen
1Division of Endocrinology and Metabolism, The EVMS Strelitz Center for Diabetes and Endocrine Disorders, Department of Internal Medicine, Eastern Virginia Medical School Norfolk, VA, USA.
Frontiers in Endocrinology
|September 7, 2012
Summary
Cardiovascular disease remains a major threat in diabetes mellitus, with glycemic control showing limited benefits for macrovascular complications. Multifactorial interventions are crucial for managing vascular outcomes in diabetic patients.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Background:
- Cardiovascular disease (CVD) causes significant morbidity and mortality in diabetes mellitus patients.
- While microvascular complications are better managed, macrovascular disease in diabetes remains a challenge.
- Current evidence on glycemic control's impact on macrovascular complications is inconclusive, especially in advanced or long-standing diabetes.
Purpose of the Study:
- To review the evidence on managing macrovascular disease in diabetes mellitus.
- To provide a balanced perspective on the literature affecting clinical treatment of diabetic patients with CVD.
- To highlight the need to reconsider a purely glucocentric approach.
Main Methods:
- Literature review of prospective trials and clinical evidence.
- Analysis of factors influencing macrovascular complications in diabetes.
- Consideration of recent guidelines and emerging data.
Main Results:
- Glycemic control benefits for macrovascular complications are limited and may depend on disease duration and burden.
- Emerging data challenges traditional pathobiology notions of diabetic macrovascular disease.
- Recent joint position statements from ADA and EASD offer guidance.
Conclusions:
- A glucocentric approach is insufficient for managing macrovascular disease in diabetes.
- Concurrent multifactorial interventions show promise in reducing vascular outcomes.
- Further research is essential for optimal management strategies.
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