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Sintesi critica delle linee guida Europee su diabete, pre-diabete e malattie cardiovascolari
No full textdiabete linee guid
Hyperglycemia and cardiovascular risk
No full textCoronary artery disease and type 2 diabetes are chronic diseases of substantial and growing prevalence. Although diabetes is a strong independent risk factor for cardiovascular events, this risk is not confined to glucose levels above the diagnostic threshold for diabetes. Rather, there is now a growing consensus that nondiabetic hyperglycemia measured by fasting glucose, postload glucose or glycated hemoglobin is a progressive, continuous risk factor for cardiovascular outcomes. Whether dysglycemia is a marker for a more complex metabolic condition or may directly contribute to excess cardiovascular risk is still a matter of debate. While strategies designed to normalize glucose levels in people with type 2 diabetes remain inconclusive, diabetes prevention trials suggest that along with reduction of the rate of conversion toward diabetes, a significant improvement in cardiovascular risk factors occurs. Moreover, a number of ongoing studies may provide answers to this question. Recognition that nondiabetic hyperglycemia is associated with an increased cardiovascular risk may suggest new ways for preventing cardiovascular disease
Changing the treatment paradigm for type 2 diabetes
Full text linkBased on the results of the U.K. Prospective Diabetes Study (UKPDS), “... treatment of type 2 diabetes [should] include aggressive efforts to lower blood glucose levels as close to normal as possible. ...” This was the recommendation the American Diabetes Association promulgated based on the results of the UKPDS when published (1). The suggestion was soon adopted by official guidelines in every region of the world (2). They are generally consistent in recommending an A1C goal of <7.0%. However, the results of the UKPDS remained inconclusive with respect to cardiovascular (CV) complications because of a risk reduction that was only close to statistical significance (−16%, P = 0.052). In support of the UKPDS results, however, a recent meta-analysis of randomized trials in type 2 diabetes (3) calculated a 19% reduction in the incidence of any type of macrovascular event associated with improved long-term glycemic control. Moreover, a strong association between glycemic control and micro- and macrovascular disease has been highlighted in type 1 diabetic patients (4,5)
Kidney dysfunction and related cardiovascular risk factors among patients with type 2 diabetes
No full textBACKGROUND:
Kidney dysfunction is a strong predictor of end-stage renal disease and cardiovascular (CV) events. The main goal was to study the clinical correlates of diabetic kidney disease in a large cohort of patients with type 2 diabetes mellitus (T2DM) attending 236 Diabetes Clinics in Italy.
METHODS:
Clinical data of 120 903 patients were extracted from electronic medical records by means of an ad hoc-developed software. Estimated glomerular filtration rate (GFR) and increased urinary albumin excretion were considered. Factors associated with the presence of albuminuria only, GFR < 60 mL/min/1.73 m(2) only or both conditions were evaluated through multivariate analysis.
RESULTS:
Mean age of the patients was 66.6 ± 11.0 years, 58.1% were male and mean duration of diabetes was 11.1 ± 9.4 years. The frequency of albuminuria, low GFR and both albuminuria and low GFR was 36.0, 23.5 and 12.2%, respectively. Glycaemic control was related to albuminuria more than to low GFR, while systolic and pulse pressure showed a trend towards higher values in patients with normal kidney function compared with those with both albuminuria and low GFR. Multivariate logistic analysis showed that age and duration of disease influenced both features of kidney dysfunction. Male gender was associated with an increased risk of albuminuria. Higher systolic blood pressure levels were associated with albuminuria, with a 4% increased risk of simultaneously having albuminuria and low GFR for each 5 mmHg increase.
CONCLUSIONS:
In this large cohort of patients with T2DM, reduced GFR and increased albuminuria showed, at least in part, different clinical correlates. A worse CV risk profile is associated with albuminuria more than with isolated low GFR
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