Abstract
In recent decades we have seen a surge in the incidence of diabetes in industrialized nations; a threat which has now extended to the developing world. Type 2 diabetes is associated with significant microvascular and macrovascular disease, with considerable impact on morbidity and mortality. Recent evidence has cast uncertainty on the benefits of very tight glycaemic goals in these individuals. The natural history of disease follows an insidious course from disordered glucose metabolism in a pre-diabetic state, often with metabolic syndrome and obesity, before proceeding to diabetes mellitus. In the research setting, lifestyle, pharmacological and surgical intervention targeted against obesity and glycaemia has shown that metabolic disturbances can be halted and indeed regressed if introduced at an early stage of disease. In addition to traditional anti-diabetic medications such as the glinides, sulphonylureas and the glitazones, novel therapies manipulating the endocannabinoid system, neurotransmitters, intestinal absorption and gut hormones have shown dual benefit in weight loss and glycaemic control normalisation. Whilst these treatments will not and should not replace lifestyle change, they will act as invaluable adjuncts for weight loss and aid in normalising the metabolic profile of individuals at risk of diabetes. Utilizing novel therapies to prevent diabetes should be the focus of future research, with the aim of preventing the challenging microvascular and macrovascular complications, and ultimately cardiovascular death.
Keywords: Diabetes, obesity, cardiometabolic, cardiovascular disease, metabolic syndrome, weight loss, renin-angiotensinaldosterone system, preventive medicine, vascular disease.
Current Vascular Pharmacology
Title:Interrupting the Natural History of Diabetes Mellitus: Lifestyle, Pharmacological and Surgical Strategies Targeting Disease Progression
Volume: 12 Issue: 1
Author(s): Kaivan Khavandi, Jack Brownrigg, Mohammed Hankir, Harpreet Sood, Naveed Younis, Joy Worth, Adam Greenstein, Handrean Soran, Anthony Wierzbicki and David J. Goldsmith
Affiliation:
Keywords: Diabetes, obesity, cardiometabolic, cardiovascular disease, metabolic syndrome, weight loss, renin-angiotensinaldosterone system, preventive medicine, vascular disease.
Abstract: In recent decades we have seen a surge in the incidence of diabetes in industrialized nations; a threat which has now extended to the developing world. Type 2 diabetes is associated with significant microvascular and macrovascular disease, with considerable impact on morbidity and mortality. Recent evidence has cast uncertainty on the benefits of very tight glycaemic goals in these individuals. The natural history of disease follows an insidious course from disordered glucose metabolism in a pre-diabetic state, often with metabolic syndrome and obesity, before proceeding to diabetes mellitus. In the research setting, lifestyle, pharmacological and surgical intervention targeted against obesity and glycaemia has shown that metabolic disturbances can be halted and indeed regressed if introduced at an early stage of disease. In addition to traditional anti-diabetic medications such as the glinides, sulphonylureas and the glitazones, novel therapies manipulating the endocannabinoid system, neurotransmitters, intestinal absorption and gut hormones have shown dual benefit in weight loss and glycaemic control normalisation. Whilst these treatments will not and should not replace lifestyle change, they will act as invaluable adjuncts for weight loss and aid in normalising the metabolic profile of individuals at risk of diabetes. Utilizing novel therapies to prevent diabetes should be the focus of future research, with the aim of preventing the challenging microvascular and macrovascular complications, and ultimately cardiovascular death.
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Khavandi Kaivan, Brownrigg Jack, Hankir Mohammed, Sood Harpreet, Younis Naveed, Worth Joy, Greenstein Adam, Soran Handrean, Wierzbicki Anthony and Goldsmith J. David, Interrupting the Natural History of Diabetes Mellitus: Lifestyle, Pharmacological and Surgical Strategies Targeting Disease Progression, Current Vascular Pharmacology 2014; 12 (1) . https://dx.doi.org/10.2174/15701611113119990118
DOI https://dx.doi.org/10.2174/15701611113119990118 |
Print ISSN 1570-1611 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6212 |
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