Delaying vascular complications of diabetes

Vascular complications are among the most common chronic complications of type 2 diabetes mellitus and the major cause of morbidity

and mortality in these patients. The risk of coronary events is increased threefold in male diabetics and even fivefold in female diabetics

in comparison with non-diabetics. In order to reduce a (very) high cardiovascular risk in diabetic patients, a combination of lifestyle measures

and medication therapy is used. Lifestyle measures favourably affect hyperglycaemic control as well as other risk factors associated

with insulin resistance. Pharmacological treatment to prevent macrovascular changes involves renin-angiotensin-aldosterone system

blockade (ACE inhibitor or AT1 blocker), management of dyslipidaemia with a statin, and administration of metformin provided there

are no contraindications. Reducing a persistent residual risk in a diabetic patient is possible with a combination with other strategies

(combination therapy for hypertension, addition of fenofibrate to the treatment of microvascular complications, choice of additional

antihyperglycaemic strategies – pioglitazone, possible incretin-based therapy of diabetes, or properly managed insulin therapy). An

actual delay or prevention of vascular complications of diabetes can be achieved by means of a comprehensive and intensive intervention

made, if possible, as early as prediabetic stages.

gliptins.

Keywords: type 2 diabetes mellitus, microvascular, macrovascular, lifestyle measures, RAS blockade, statins, fibrates, metformin, pioglitazone,