Diabetes and cardiovascular disease

THE aim of management in type 2 diabetes is to reduce long-term complications, most importantly cardiovascular events arising from macrovascular and microvascular complications. 

With the recent availability of new antiglycaemic medicines, attention has been focused on achieving blood glucose reduction with targets set around the surrogate endpoint of HbA1c results. 

A combined approach that targets glucose lowering, lipid lowering, and blood pressure control is likely to be most beneficial, rather than a focus on HbA1c. 

A recent meta-analysis has suggested that cardiovascular benefits of intensive glucose lowering are limited.1 In 13 studies (n=34,533 patients), intensive glucose lowering treatment (primary treatment target of HbA1c <7%) had no significant effect on all-cause mortality or cardiovascular death, but increased the risk of severe hypoglycaemia more than twofold. There was, however, a 15% reduction in non-fatal