Type 2 diabetes over time associates with the development of vascular complications (1). The causative role of long-term elevation of blood glucose is well established, at least for microvascular complications, since intervention strategies directed at reducing hyperglycemia lower onset and/or progression of microangiopathy (1,2). The role of hyperglycemia and its treatment in the development of macrovascular complications is less well established. In fact, it takes a longer time to observe a positive effect of better blood glucose control (in addition to reducing the multiple risk factors often associated with type 2 diabetes such as hypertension, visceral obesity, and hyperdyslipidemia) on macroangiopathy compared with microangiopathy (1,3,4). Today’s understanding of the complex relationship between hyperglycemia and complications in type 2 diabetes predicates that only an early and aggressive blood glucose–lowering intervention (in addition to reduction of the above mentioned risk factors), successfully sustained over time, will translate into benefits on macrovascular complications several years later (likely 10–15 years) (1,3–5). Thus, the present recommendation is to intensively treat people with type 2 diabetes from the clinical onset of the disease, particularly subjects with short diabetes duration who likely have not yet developed vascular complications and who presumably have a long life-expectancy (6). At present, the question is not whether to intensively treat people with type 2 diabetes at onset of the disease to prevent long-term complications. The question rather is how to intensively treat type 2 diabetes over the many years and decades of the progression of the disease to consistently keep A1C levels <7.0% over the entire cycle of type 2 diabetes. At present, this question is difficult to answer, primarily because of the lack of evidence of long-term effects of one specific intervention, compared with several other possible intervention strategies (7) in type 2 diabetes. In addition, one should always keep in mind that type 2 diabetes is a complex disease characterized by large heterogeneity among individuals and variable progression over time that may eventually result in a nearly total loss of pancreatic β-cell function in just a few years (8,9).

Pivotal role of timely basal insulin replacement after metformin failure in sustaining long-term blood glucose control at a target in Type 2 diabetes.

BOLLI, Geremia Brunetto;LUCIDI, Paola;PORCELLATI, Francesca;FANELLI, Carmine Giuseppe
2011

Abstract

Type 2 diabetes over time associates with the development of vascular complications (1). The causative role of long-term elevation of blood glucose is well established, at least for microvascular complications, since intervention strategies directed at reducing hyperglycemia lower onset and/or progression of microangiopathy (1,2). The role of hyperglycemia and its treatment in the development of macrovascular complications is less well established. In fact, it takes a longer time to observe a positive effect of better blood glucose control (in addition to reducing the multiple risk factors often associated with type 2 diabetes such as hypertension, visceral obesity, and hyperdyslipidemia) on macroangiopathy compared with microangiopathy (1,3,4). Today’s understanding of the complex relationship between hyperglycemia and complications in type 2 diabetes predicates that only an early and aggressive blood glucose–lowering intervention (in addition to reduction of the above mentioned risk factors), successfully sustained over time, will translate into benefits on macrovascular complications several years later (likely 10–15 years) (1,3–5). Thus, the present recommendation is to intensively treat people with type 2 diabetes from the clinical onset of the disease, particularly subjects with short diabetes duration who likely have not yet developed vascular complications and who presumably have a long life-expectancy (6). At present, the question is not whether to intensively treat people with type 2 diabetes at onset of the disease to prevent long-term complications. The question rather is how to intensively treat type 2 diabetes over the many years and decades of the progression of the disease to consistently keep A1C levels <7.0% over the entire cycle of type 2 diabetes. At present, this question is difficult to answer, primarily because of the lack of evidence of long-term effects of one specific intervention, compared with several other possible intervention strategies (7) in type 2 diabetes. In addition, one should always keep in mind that type 2 diabetes is a complex disease characterized by large heterogeneity among individuals and variable progression over time that may eventually result in a nearly total loss of pancreatic β-cell function in just a few years (8,9).
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11391/355494
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