Antihyperglycaemic treatment and vascular diseases

Hyperglycaemia is being linked to the development of vascular complications of diabetes - diabetic micro- as well as macro-angiopathies. It is, therefore, logical to assume that a reduction of glycaemia will result in a reduction of diabetic complications. However, recent clinical studies in type 2 diabetes described a range of observations that make this general statement less unambiguous: possibly increased incidence of coronary events following rosiglitazone use, discontinuation of some studies due to significantly decreased HbA_1c in long-term diabetes, metabolic memory phenomenon, where early diabetes treatment exerts it effect for more than 10 years, and resulting differences in treatment approach to type 2 diabetes patients with respect to the duration of the disease. It can be concluded with respect to the issue of antihypeglycaemia treatment and its cardiovascular effect: 1. Early compensation of diabetes in newly diagnosed diabetic patients exerts its effect as long as 15 years and more. 2. Longer duration of diabetes implicates probably higher target value for diabetes compensation than the current 5.3% HbA_1c according to IFCC. 3. No link has been proven between a specific anti-diabetic agent and worsened cardiovascular prognosis; the RECORD study provided conclusive evidence that rosiglitazone has no negative effect on the vascular system. 4. On contrary, it is very likely that some of the new anti-diabetic agents, for example from among the incretin analogues, will impact positively on the vascular system. 5. There is no doubt about the importance of hyperglycaemia correction in prevention of cardiovascular diseases in type 1 diabetes patients.

Keywords: diabetes mellitus; anti-diabetic agents; cardiovascular complication of diabetes; metformin; glitazones; incretin analogues; metabolic memory