Treatment of type 2 diabetes: New clinical studies and effects of GLP-1 on macrovascular complications.

Abstract

Various publications in 2009 showed that the treatment of type 2 diabetic (T2D) patients with macrovascular complications is still a controversial subject, whether with regard to the use of glitazones, to the best management strategy for T2D patients with stable coronary artery disease or to the use of incretin mimetic drugs in patients with heart disease. The Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of glycemia in Diabetes study (RECORD) compared cardiovascular morbidity-mortality outcomes in patients taking rosiglitazone in combination with metformin or sulfonylurea versus metformin with sulfonylurea. The results showed that rosiglitazone was not inferior to the metformin-sulfonylurea combination in terms of mortality and cardiovascular hospitalization, but caution must be used when interpreting the results, as the event rate was low. The BARI 2D study (Bypass Angioplasty Revascularization Investigation 2 Diabetes) is a cardiovascular morbidity-mortality trial with the goal of determining the best strategy for blood glucose control and revascularization in T2D patients with stable coronary artery disease. The results of this trial showed that early revascularization is not clearly beneficial, except in a subgroup of patients in whom surgical revascularization is indicated. The use of GLP-1 analogs (Glucagon-Like Peptide-1) in the acute phase of myocardial ischemia in animal models provided promising results. Some clinical studies also suggest an improvement in cardiovascular risk factors with these treatments. Results from morbidity-mortality studies are needed to better assess the long-term efficiency of these new drugs.

• Authors: S Lesven, J-F Gautier, R Maréchaud
• Journal: Annales d'endocrinologie (Ann Endocrinol (Paris)) Vol. 71 Issue 6 Pg. 505-10 (Dec 2010) ISSN: 2213-3941 [Electronic] France
• PMID: 21030006 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Chemical References

• Hypoglycemic Agents
• Thiazolidinediones
• Rosiglitazone
• Glucagon-Like Peptide 1

Topics

• Animals
• Coronary Artery Disease (drug therapy, etiology)
• Diabetes Mellitus, Type 2 (drug therapy, pathology)
• Diabetic Angiopathies (drug therapy, pathology)
• Glucagon-Like Peptide 1 (therapeutic use)
• Heart Diseases (drug therapy, etiology)
• Humans
• Hypoglycemic Agents (adverse effects, therapeutic use)
• Risk Factors
• Rosiglitazone
• Thiazolidinediones (adverse effects, therapeutic use)