Title:Glucose and LDL Lowering: The Need for Intensive Therapy
VOLUME: 10 ISSUE: 6
Author(s):Stefano Del Prato
Affiliation:Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Italy.
Keywords:Type 2 diabetes, glycemic control, Intervention trials, cardiovascular disease, LDL-cholesterol
Abstract:In almost every epidemiological analysis so far performed a strong correlation always emerges between degree
of hyperglycemia and risk of both micro- and macrovascular complications. However, whereas lowering plasma glucose
levels by intensive treatment has proven to reduce the risk of development of retinopathy, nephropathy and neuropathy,
the effect on macrovascular complications has remained quite doubtful. Multiple factors may have concurred to this negative
findings including long duration of diabetes, poor pre-existing glycaemic control, potentially inadequate anti-diabetes
drugs. Another potential explanation is that, given the high cardiovascular risk of the diabetic patients they were already
aggressively treated as far as their cardiovascular risk factors are concerned. The annual mortality in these diabetic cohorts
was, indeed, incredibly close to that of the non-diabetic population. These considerations along with the results of multiintervention
studies, such as the Steno-2, supports the need for multifactorial intensive needs, definitely including glucose
and lipid lowering.
