The benefits of the treatment of diabetes mellitus (DM).
Maintaining normoglycemia can reduce the risk of microvascular damage to the kidneys and eyes. However, evidence of a reduction in the risk of coronary heart disease (CHD) with the help of tight glycemic control is not enough. In the DCCT study, the apparent reduction in the number of coronary events among patients with diabetes-1 who were given intensive therapy did not reach statistical significance with the updated analysis, possibly due to the relatively small number of events in the relatively young cohort.
In diabetes-2, hypoglycemic drugs per os and insulin may improve glycemic control, but their role in reducing the risk of macrovascular complications remains unclear. Studies by ASCOT-BPLA and HORE have shown that treatment with an ACE inhibitor may reduce the occurrence of new cases of diabetes, but this was not confirmed in the prospective DREAM study, which was designed to directly answer this question. On the other hand, in the same study, it was found that rosiglitazone (a drug commonly used to treat diabetes mellitus 2) can slow the onset of clear diabetes, although the long-term usefulness of this approach remains unknown.
“Aggressive” multifactorial interventions in diabetes are effective in reducing KBS events. In a study of 160 patients with DM-2 and MAU who were prescribed conventional or intensive therapy (lifestyle changes and pharmacological interventions were aimed at maintaining HbA1C. <6.5%, total cholesterol <175 mg / dl, TG <150 mg / dl and blood pressure <130/80 mmHg. Art.), the frequency SSSob decreased by> 50% over the observation period> 8 years (RR 0.47; 95% CI 0.24-0.73).
Given the favorable results in diabetic patients who participated in studies to reduce the cardiovascular event (SSSob) with the help of statins, aspirin and ACE inhibitors, it is nevertheless necessary to emphasize the importance of lifestyle changes. Improvement in screening is also necessary if we want patients with diabetes to benefit from these advances. In the Medicare study, lipids were not evaluated in 50% of patients with diabetes . The most important in relation to CVD is the analysis of subgroups in large placebo-controlled studies of cholesterol and TG-lowering therapy, which showed that the benefits of this therapy are the same in patients with diabetes and in patients without diabetes.
Guidelines and recommendations for the control of diabetes mellitus (DM). Diet and physical training are integral components of the treatment of patients with diabetes. In many patients with DM-2, glycemic control can be achieved by moderately reducing body weight through diet and increasing physical activity (PA).
In contrast to patients with DM-1, patients with DM-2 are more likely to have multiple cardiovascular RFs than in the general population. Thus, patients with diabetes need an “aggressive” modification of associated RFs, including the treatment of hypertension, a reduction in cholesterol level and body weight, and an increase in physical activity is extremely important in reducing the risk of coronary heart disease (CHD).
In the American Diabetes Association, it is recommended to treat patients with diabetes with hypertension to target blood pressure <130/80 mm Hg. st. Patients with borderline values (MAP <139 mmHg or DBP <89 mmHg) should be recommended lifestyle changes and behavioral therapy for 3 months. If GARDEN> 140 mm wg. st. or dad> 90 mm Hg. Art., I need drug therapy with an ACE inhibitor or an ARB. Current NCEP recommendations consider diabetes to be equivalent to KBS. Thus, for patients with diabetes even without KBS, the target cholesterol cholesterol level is <100 mg / dl. First you need to change the lifestyle, and then assign statins (if necessary), which at the initial level of cholesterol <130 mg / dL can be assigned immediately.
If the level of cholesterol HDL is <40 mg / dl, fibrate can be used A decrease in body weight and an improvement in glycemic control are the initial therapy for THG. Additional therapy for reducing TG can be high doses of statins (for individuals with simultaneously elevated levels of LDL and TG cholesterol), fibrates or niacin. The use of drugs that inhibit the absorption of cholesterol in the intestines, such as ezetemib, also leads to an increase in cholesterol cholesterol levels, however, there is no evidence of a decrease in the number of CBSob in monotherapy as well as in combination.
The American Diabetes Association also recommends daily use of small doses of aspirin by diabetic patients with signs of large vessel disease (for example, those who have had myocardial infarction, vascular bypass surgery, cerebral stroke (MI), or transient ischemic attack (TIA), who have PAD, intermittent claudication, angina), and for patients> 40 years old without signs of cardiovascular disease (CVD) or having a high SSR due to smoking, hypercholesterolemia, hypertension or obesity.