Lessons learned from landmark trials of type 2 diabetes mellitus and potential applications to clinical practice.
Landmark studies have demonstrated that diabetes is a significant risk factor for cardiovascular disease and mortality. Strong relationships exist between insulin resistance/hyperglycemia and mortality, microvascular complications, and cardiovascular complications. Lipid abnormalities frequently associated with type 2 diabetes and insulin resistance include low high-density lipoprotein cholesterol (HDL-C) and elevated triglyceride levels. Lowering low-density lipoprotein cholesterol levels has been shown to improve the prognosis of patients with diabetes, and increasing HDL-C levels will significantly reduce the incidence of major coronary events. Higher levels of insulin sensitivity are associated with thinner intimal-medial thickness of the carotid artery, which indicates less atherosclerosis. Thiazolidinediones increase insulin sensitivity, decrease intimal-medial thickness, and appear to have inhibitory effects on the progression of atherosclerotic lesions. It is hoped that by preventing the onset of diabetes in high-risk individuals--and improving insulin sensitivity with lifestyle changes or pharmacologic treatment--the profound complications of type 2 diabetes will be prevented or delayed, as well.
Drexler
Andrew J
AJ
Mount Sinai Diabetes Center, Mount Sinai Medical Center, 1200 5th Ave, Box 1616, New York, NY 10029, USA. andrew_drexler@smtplink.mssm.edu
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D012307:Risk Factors; D013844:Thiazoles / Q000627:therapeutic use; D045162:Thiazolidinediones
D000806:Angiotensin-Converting Enzyme Inhibitors; D007004:Hypoglycemic Agents; D013844:Thiazoles; D045162:Thiazolidinediones; C089946:2,4-thiazolidinedione