Med Sci Monit 1999; 5(5): RA1013-1019 :: ID: 503445
It is expected that the number of patients suffering from diabetes mellitus will increase in the near future. The high rate of microvascular and macrovascular complications developing in these patients will place an even higher burden on our health care systems. Several pathophysiological factors are involved in the development of complications, among which the hyperglycaemia per se, the consequent formation of advanced glycation end products and the intracellular accumulation of sorbitol. In addition, hypertension and dyslipidaemia also play an important role, especially in the development of coronary heart disease and stroke. The major therapeutic goals in type 2 diabetic patients are to optimize blood glucose control, to reduce overweight and to normalize lipid disturbances and elevated blood pressure, in order to improve the well-being of the patient and reduce the risk for the development of late diabetic complications. The UKPDS has clearly demonstrated that achievement of near-normoglycaemia - with sulfonylurea and/or insulin - can reduce the severity of microvascular complications, and that aggressive lowering of elevated blood pressure - with a beta-blocker or an ACE inhibitor - reduces both micro- and macrovascular complications. Secondary intervention studies have demonstrated the beneficial effects of treatment with beta-blockers, aspirin, and inhibitors of cholesterol synthesis, in diabetic patients after myocardial infarction or with angina pectoris. For coronary revascularisation, a preference for CABG in comparison with PTCA in diabetic patients with coronary multivessel disease was suggested. In addition, aggressive near-normalisation of blood glucose levels in the acute phase of myocardial infarction improves prognosis, and reduces 1-year mortality by 31%.
Keywords: treatment, type 2 diabetic patients, Diabetes Mellitus
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