Intensive Integrated Therapy of Type 2 Diabetes

Abstract

The macro-and microvascular burden of type 2 diabetes is well established. A number of recent single risk factor intervention trials targeting hyperglycemia, dyslipidemia, hypertension, procoagulation, microalbumuria, and existing cardiovascular disorders have, however, shown major beneficial effects on long-term outcome. The results from these studies are anticipated to change the future management of type 2 diabetes, and most of the updated national guidelines for the treatment of type 2 diabetes recommend a multipronged approach driven by ambitious treatment targets. The outcome of this intensive integrated therapy has, however, only been investigated in a few studies of patients with type 2 diabetes. One of these trials, the Steno-2 Study, showed that intensive intervention for an average of 7.8 years cuts cardiovascular events as well as nephropathy, retinopathy, and autonomic neuropathy by about half when compared with a conventional multifactorial treatment. The challenge for now is to ensure that the trial experiences are widely adopted in daily clinical practice. Diabetes 53 (Suppl. 3)

Considerably decreased risk of cardiovascular disease with combined reductions in HbA1c, blood pressure and blood lipids in type 2 diabetes: Report from the Swedish National Diabetes Register

“…8 The subgroup of patients with albuminuria at baseline was added here for comparison with the Steno study of patients with type 2 diabetes and albuminuria at baseline, which has reported a relative risk decrease of 67% for fatal CVD and 56% for total mortality after an intervention period achieving superior effect on risk factors with intensive treatment, regarding HbA1c, total and LDL cholesterol, SBP and rate of urine albumin excretion. 6,7 Comparatively, the combined decrease in HbA1c, SBP and non-HDL:HDL achieved in Group 4 of our patients with albuminuria was associated with a relative risk reduction of around 57% (p = 0.002) for fatal CVD and 49% (p < 0.001) for total mortality, compared to our reference Group 1.…”

“…This observational study of change in relevant cardiovascular risk factors should be regarded as additional evidence and complement to findings in previous randomized trials in type 2 diabetes on the importance of intensive treatment of the individual risk factors glucose, blood pressure and blood lipids, 26,31,32 and also on the effect of combined treatment of these risk factors. [5][6][7] …”

“…The Steno-2 study, analysing patients with type 2 diabetes and baseline presence of albuminuria, found that intensive intervention on life-style changes and use of multiple drug combinations demonstrated the proportionate importance of glycaemic control, blood pressure lowering and lipid management, and this intervention was associated with significantly lower risk of CVD events and mortality. 6,7 However, no attempt was made to ascertain the independent contribution of each treated risk factor to the CVD risk reduction. One previous observational study from Kaiser Permanente in type 2 diabetes has analysed the concomitant long-term control of three cardiovascular risk factors, HbA1c, systolic blood pressure (SBP) and low-density lipoprotein (LDL) cholesterol, each of them alone or in various combinations, for the beneficial effects on risk for nonfatal CVD hospitalization, showing reduced CVD risk with several of the targets achieved compared to none achieved.…”

“…Additive effects in treatment of HbA1c and blood pressure have been shown in several previous studies of patients with type 2 diabetes. [1][2][3][4][5][6][7][8] A recent Swedish National Diabetes Register (NDR) study showed additive effects for the combination of hyperglycaemia and hyperlipidaemia on risk for CVD in type 2 diabetes [although less than additive for coronary heart disease (CHD)]. 4 The lipid variable was the stronger effect predictor, although HbA1c also was a strong risk factor.…”

Bevölkerungspolitik im Kontext ökologischer Generationengerechtigkeit

“…Im Jahr 1972 lebten im früheren Bundesgebiet 55 Prozent der Bevölkerung mit Kindern unter 18 Jahren zusammen (68,5 Prozent mit ledigen Kindern ohne Altersbegrenzung 673 GEO behauptet, dass das Ticken der "Zeitbombe Demografie" noch von zu wenigen gehört würde und dass Bürgermeister beschönigend von "negativem Wachstum" und "Stadtentwicklung rückwärts" redeten. 674 Die deutsche Bevölkerungswissenschaft war nach der NS-Herrschaft zurück-haltend geworden, demografische Zustände zu bewerten. 675 Erst in den letzten Jahren ist diese Einstellung abgelöst worden durch eine pronatalistische Haltung, die heute an allen deutschen Lehrstühlen außer Rostock vertreten wird.…”