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Controversies in the cardiovascular management of type 2 diabetes

Opie, LH; Yellon, DM; Gersh, BJ; (2011) Controversies in the cardiovascular management of type 2 diabetes. HEART , 97 (1) 6 - 14. 10.1136/hrt.2010.214031.

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Abstract

In patients with type 2 diabetes mellitus, intense control of blood pressure, lipids and glucose, aiming at theoretically ideal values, is bought at a cost. Intense blood pressure control has renal complications. Intense lipid control, thus far, has worked for reduction of low-density lipoprotein-cholesterol, paradoxically at the cost of a small increase in new diabetes. Intense control of glycaemia generally requires insulin added to oral agents, which is consistently accompanied by weight gain, while increased hypoglycaemia has a long-term risk of cerebral damage. Intense glycaemic control has not consistently reduced mortality, whereas a strategy based on tight control of lipids and blood pressure with modestly tight glucose control has succeeded. Looking to the future, incretin mimetics may come to the fore as prime agents because they can reduce weight and glycaemia with little significant hypoglycaemia, thereby making tight glucose control easier to achieve.

Type:Article
Title:Controversies in the cardiovascular management of type 2 diabetes
DOI:10.1136/hrt.2010.214031
Keywords:CORONARY-ARTERY-DISEASE, RANDOMIZED CONTROLLED-TRIAL, BLOOD-PRESSURE CONTROL, ACUTE MYOCARDIAL-INFARCTION, CONGESTIVE-HEART-FAILURE, GLUCOSE CONTROL, GLYCEMIC CONTROL, OXIDATIVE STRESS, FATTY-ACID, MICROVASCULAR COMPLICATIONS
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science

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