[To observe, or to observe and to act?].
The UKPDS Study has clearly shown that diagnosis and therapeutic management of type 2 diabetes and its complications occur lately in the course of the disease, and that diabetes control deteriorates and micro- and macrovascular complications risk increase with the duration of the disease. Recent data from the STENO-2 study demonstrate the cardiovascular benefit of an intensified multifactorial management of diabetes and associated cardiovascular risk factors in type 2 diabetic patients at high cardiovascular risk. This paper advocates for an early intensive management of type 2 diabetes from the diagnosis in order to maintain glycaemia and glycosylated haemoglobin at the lowest possible level (even less than the current recommended levels) and for an early aggressive management of all known risk factors (including overweight and obesity, elevated arterial blood pressure, dyslipidaemias, etc.). This implies the early use of multiple therapy at adequate doses and a dramatic change in conventional medical habits, from a late and delayed management of diabetes and its complications to their early prevention using all therapeutic resources.
Slama
G
G
Service de Diabétologie, Hôtel-Dieu F-75181 PARIS Cedex 4. gerald.slama@htd.ap-hop-paris.fr
D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D009765:Obesity / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin