title: Glucose Control and Vascular Outcomes in Type 2 Diabetes: Is the Picture Clear?
abstract: The overall impact of glucose lowering on vascular complications and major clinical outcomes, including mortality, in type 2 diabetes is still an open issue. While intensive glucose control has undoubted benefit for microvascular end points, the relationship between glucose-lowering approaches and reduced incidence and/or progression of macrovascular complications is less clear. This review article will discuss the effect of glucose lowering per se as well as the effects of specific glucose-lowering therapies on vascular outcomes in type 2 diabetes. The role of lifestyle changes on cardiovascular outcomes will be also addressed. Recent analyses from large cardiovascular outcome studies (ACCORD, ADVANCE, and VADT) provide new information on factors that modulate the impact of intensive glucose lowering on outcomes, helping to identify the specific clinical characteristics of the patients receiving the intervention that would show a better response. While several studies on cardiovascular outcomes with diabetes drugs are available, they do not clearly highlight a benefit from using a specific medication or will require additional evidence, as for the sodium-glucose cotransporter 2 blockers.
authors.affiliation: Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy francesco.giorgino@uniba.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giorgino
authors.affiliation: Institute for Cellular Medicine-Diabetes, Newcastle University, Newcastle-upon-Tyne, U.K.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Home
authors.affiliation: Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland Center for Vascular Prevention, Danube-University Krems, Krems, Austria Dasman Diabetes Institute, Dasman, Kuwait Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
mesh_terms: D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006442:Glycated Hemoglobin / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human