Control of type 2 diabetes mellitus: problems and prospects for their solution

Important medico-social and economic implications of type 2 diabetes mellitus (DM2) are determined by its continuously growing prevalence, frequencyand severity of complications related to inadequate glycemic control. Large-scale studies (UKPDS, VADT, ACCORD, ADVANCE) havedemonstrated controversial effect of intensive glycemic control (estimated from HbA1c dynamics) on diabetic macrovascular complication. At thesame time, epidemiological, experimental, and observational studies yielded conclusive evidence of postprandial glycemia (PPG) contribution tooverall glycemic control and its role in the development of macrovascular complications. For this reason, PPG control is currently given as much attentionas traditional parameters (HbA1c and fasting glycemia). Dipeptidyl peptidase-IV (DPP-IV) inhibitors are a new class of hypoglycemic agentsthat raise levels of incretins, glucagons-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) in blood by suppressing DPPIVactivity. The resulting recovery of physiological insulin secretion promotes reduction of fasting and postprandial glycemia and HbA1c level.

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Cardiovascular benefits of sodium-glucose cotransporter 2 inhibitors in diabetic and nondiabetic patients

Cardiovascular Diabetology ◽

10.1186/s12933-021-01266-x ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Boyang Xiang ◽

Xiaoya Zhao ◽

Xiang Zhou

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glycemic Control ◽

Large Scale ◽

Protective Effects ◽

Beneficial Effects ◽

Sodium Glucose Cotransporter ◽

Outcome Trial

AbstractSodium-glucose cotransporter 2 inhibitors (SGLT2i) were developed as antidiabetic agents, but accumulating evidence has shown their beneficial effects on the cardiovascular system. Analyses of the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) suggested that these benefits are independent of glycemic control. Several large-scale outcome trials of SGLT2i also showed cardiovascular benefits in nondiabetic patients, strengthening this perspective. Extensive animal and clinical studies have likewise shown that mechanisms other than the antihyperglycemic effect underlie the cardiovascular benefits. Recent clinical guidelines recommend the use of SGLT2i in patients with type 2 diabetes mellitus and cardiovascular diseases because of the proven cardiovascular protective effects. Since the cardiovascular benefits are independent of glycemic control, the therapeutic spectrum of SGLT2i will likely be extended to nondiabetic patients.

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SUN-696 Effect of Night Shifts on Glycemic Variability in Patients with Type 2 Diabetes

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1442 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Mayya Akakievna Garieva

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Carbohydrate Metabolism ◽

Work Experience ◽

High Variability ◽

Postprandial Glycemia ◽

Fasting Glycemia ◽

Night Shifts

Abstract The analysis of indicators of carbohydrate metabolism and variability of glycemia in patients with type 2 diabetes mellitus working in night shifts was carried out. As model patients with impaired circadian rhythm, the study included 34 patients, railway transport drivers, with shift mode and the presence of night shifts, with work experience of more than 5 years, the duration of type 2 diabetes mellitus (DM2) from 1 to 7 years, who are on oral therapy with hypoglycemic drugs. Simulation of different working conditions (day-night) was carried out in the simulator “driver’s cabin”. All patients underwent a study of the main indicators of carbohydrate metabolism (fasting glycemia, postprandial glycemia, glycated hemoglobin (HbA1c)), as well as continuous daily glucose monitoring (CGMS) using Medtronic MiniMed iPro2 system (from 3 to 7 days). Target glycemic levels were not achieved: fasting glycemia was 6.98±1.41 mmol/l; postprandial glycemia was 9.57±1.65 mmol/l; HbA1c was 7.23±1.62%. The analysis of CGMS revealed high variability of glycemic index MAGE-4.88±0.59 mmol/l. also calculated indicators SD - 1.52±0.63 mmol/l; Conga - 3.17±0.54 mmol/l; MODD - 2.27±0.12 mmol/l. The period of hyperglycemia (glucose value above 7.8 mmol/l) according to the results of CGMS was 43.5% (min 19-max 56). The duration of hypoglycemic States in patients without night shifts was 2.4% within 24 hours (min 0-max 6.6). Correlation analysis between carbohydrate metabolism and glucose variability revealed a significant strong relationship between the level of postprandial glycemia and modd (r=0.87, P=0.001) and MAGE (r=0.82, P=0.01), and also established a mean significant correlation between the level of postprandial glucose and Conga (r=0.52, P=0.01) and SD (r=0.61, P=0.05). Fasting glycemia and congas were moderately correlated (r=0.4, P=0.01). Weak reliable correlation was found only between HbA1c level and Conga variability index (r=0.27, P=0.04). Conclusions: the results of the study indicate the lack of adequate glycemic control in persons working night shifts, high variability of glycemia, which is an independent risk factor for cardiovascular disease in patients with DM2. The associative relationship of fasting glycemia and postprandial with the indicator of variability Conga shows that glucose fluctuations during the day in patients are constant.

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