Challenges in the Management of Type 2 Diabetes Mellitus and Cardiovascular Risk Factors in Obese Subjects: What Is the Evidence and What Are the Myths?
Table 1
Summary of the results of the major trials.
Look AHEAD trial
Intensive lifestyle intervention (ILI) is superior to conventional diabetes education in inducing weight loss and partial or complete remission of diabetes mellitus. No benefit of ILI, however, on cardiovascular outcomes was noted
ACCORD trial
Five-year results confirm that neither more intensive lowering of blood glucose levels and more intensive lowering of blood pressure nor treatment of blood lipids with a fibrate and a statin drug reduces cardiovascular risk in people with established type 2 diabetes who are at severely high risk for cardiovascular events. However, the study did find improvements to microvascular conditions. Also, more deaths from any cause and fewer nonfatal myocardial infarctions were observed
VADT
Intensive glucose control in patients with poorly controlled type 2 diabetes had no significant effect on the rates of major cardiovascular events, death, or microvascular complications, with the exception of progression of albuminuria
ADVANCE trial
Intensive medical/antiglycemic therapy did not show any macrovascular benefit despite better diabetes control and improvement in cardiovascular risk factors, but it did show a reduction in microvascular events
UKPDS study
Intensive antiglycemic therapy in newly diagnosed type 2 diabetics without overt coronary heart disease resulted in reduction in coronary events. Study’s 10-year follow up concluded that despite the loss of glycemic differences between the two groups, a continued reduction in microvascular risk and an overall risk reduction for myocardial infarction and death from any cause were observed
STENO trial
It concluded that a focused multifactorial intervention that includes pharmacological therapy along with behavioral modification and aspirin therapy decreased the risk of cardiovascular disease and the overall levels of glycosylated hemoglobin, blood pressure, and cholesterol and triglycerides levels as well as urinary albumin excretion
