title: Controversies in the cardiovascular management of type 2 diabetes.
abstract: In patients with type 2 diabetes mellitus, intense control of blood pressure, lipids and glucose, aiming at theoretically ideal values, is bought at a cost. Intense blood pressure control has renal complications. Intense lipid control, thus far, has worked for reduction of low-density lipoprotein-cholesterol, paradoxically at the cost of a small increase in new diabetes. Intense control of glycaemia generally requires insulin added to oral agents, which is consistently accompanied by weight gain, while increased hypoglycaemia has a long-term risk of cerebral damage. Intense glycaemic control has not consistently reduced mortality, whereas a strategy based on tight control of lipids and blood pressure with modestly tight glucose control has succeeded. Looking to the future, incretin mimetics may come to the fore as prime agents because they can reduce weight and glycaemia with little significant hypoglycaemia, thereby making tight glucose control easier to achieve.
authors.affiliation: The Hatter Cardiovascular Institute, University College London Hospital and Medical School, 67 Chenies Mews, London WC1E 6HX, UK.
authors.forename: Lionel H
authors.initials: LH
authors.lastname: Opie
authors.forename: Derek M
authors.initials: DM
authors.lastname: Yellon
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000517:prevention & control*; D058065:Diabetic Cardiomyopathies / Q000209:etiology; D005227:Fatty Acids / Q000378:metabolism; D058607:Fibric Acids / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000378:metabolism; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000517:prevention & control; D006973:Hypertension / Q000517:prevention & control; D007003:Hypoglycemia / Q000209:etiology; D007004:Hypoglycemic Agents / Q000009:adverse effects; D012307:Risk Factors; D045162:Thiazolidinediones / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D005227:Fatty Acids; D058607:Fibric Acids; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D045162:Thiazolidinediones