Early intensification of therapy for type 2 diabetes mellitus and achievement of the target level of glycohemoglobin HbA 1c  are necessary factors to reduce the risk of micro- and macrovascular complications

M. S. Shamkhalova; O. Y. Sukhareva

doi:10.14341/DM13079

Early intensification of therapy for type 2 diabetes mellitus and achievement of the target level of glycohemoglobin HbA_1c are necessary factors to reduce the risk of micro- and macrovascular complications

M. S. Shamkhalova, O. Y. Sukhareva

https://doi.org/10.14341/DM13079

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Abstract

Control of type 2 diabetes mellitus (T2DM) requires multifactorial behavioral and pharmacological treatment to prevent the development or slow the progression of complications. The main characteristics of T2DM — hyperglycemia and insulin resistance, combined with oxidative stress, low-level inflammation, epigenetic changes, genetic predisposition, activation of the renin-angiotensin-aldosterone system, causing endothelial dysfunction, are responsible for the metabolic environment that increases vascular risk in patients. Almost all patients with type 2 diabetes are at high and very high cardiovascular risk. The largest studies of the late XX-early XXI centuries. demonstrated a significant reduction in complications with intensive care early in the course of the disease and a «legacy effect» with the long-term historical value of HbA_1c control during their observational follow-ups. The decrease in HbA_1cmay also play a role in mediating the positive effect on cardiovascular risk observed with the use of new hypoglycemic agents. The desire for glycemic control and the desire for organ-specific protection are not mutually exclusive, but complementary. Reassessing individual glycemic goals and achieving them at regular intervals with early intensification of therapy is key to overcoming clinical inertia.

Keywords

type 2 diabetes mellitus, glycohemoglobin HbA_1c, vascular complications, clinical inertia, gliclazide MR

About the Authors

M. S. Shamkhalova

Endocrinology Research Centre
Russian Federation

Minara S. Shamkhalova - MD, PhD.

11 Dm. Ulyanova street, 117036 Moscow

Competing Interests:

Шамхалова М.Ш. — участник экспертных советов компаний Мерк, АстраЗенека, Берингер Ингельхайм, Астеллас Фарма, Санофи, Ново Нордиск, Эли Лилли.

O. Y. Sukhareva

Endocrinology Research Centre
Russian Federation

Olga Y. Sukhareva - MD, PhD.

Moscow

Competing Interests:

Сухарева О.Ю. — участник экспертных советов компаний Мерк, АстраЗенека, Берингер Ингельхайм, Астеллас Фарма, Санофи, Ново Нордиск, Эли Лилли.

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Supplementary files

	1. Figure 1. Death from any cause and previous glycated hemoglobin (%) according to the UKPDS study [11].
	Subject
	Type	Исследовательские инструменты
	View (81KB)	Indexing metadata ▾

	2. Figure 2. Intensive glycemic control and microvascular outcomes (ADVANCE study) [17].
	Subject
	Type	Исследовательские инструменты
	View (345KB)	Indexing metadata ▾

	3. Figure 3. Correlation between the magnitude of the decrease in the level of glycated hemoglobin and the risk of major adverse cardiovascular events (meta-regression analysis of 12 CVOTs) [19].
	Subject
	Type	Исследовательские инструменты
	View (106KB)	Indexing metadata ▾

	4. Figure 4. International guidelines and recommendations for the treatment of type 2 diabetes mellitus (target levels of glycated hemoglobin) [21-26].
	Subject
	Type	Исследовательские инструменты
	View (165KB)	Indexing metadata ▾

	5. Figure 5. Individualized choice of therapy goals based on glycated hemoglobin (Russian clinical guidelines 2022 "Type 2 diabetes mellitus in adults") - do not apply to pregnant women [27].
	Subject
	Type	Исследовательские инструменты
	View (317KB)	Indexing metadata ▾

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For citations:

Shamkhalova M.S., Sukhareva O.Y. Early intensification of therapy for type 2 diabetes mellitus and achievement of the target level of glycohemoglobin HbA_1c are necessary factors to reduce the risk of micro- and macrovascular complications. Diabetes mellitus. 2023;26(4):343-351. (In Russ.) https://doi.org/10.14341/DM13079

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	Title	Figure 1. Death from any cause and previous glycated hemoglobin (%) according to the UKPDS study [11].
	Type	Исследовательские инструменты
	Date	2023-09-01
Digital Object Identifier	https://doi.org/10.14341/DM13079-6748

	Title	Figure 2. Intensive glycemic control and microvascular outcomes (ADVANCE study) [17].
	Type	Исследовательские инструменты
	Date	2023-09-01
Digital Object Identifier	https://doi.org/10.14341/DM13079-6749

	Title	Figure 3. Correlation between the magnitude of the decrease in the level of glycated hemoglobin and the risk of major adverse cardiovascular events (meta-regression analysis of 12 CVOTs) [19].
	Type	Исследовательские инструменты
	Date	2023-09-01
Digital Object Identifier	https://doi.org/10.14341/DM13079-6750

	Title	Figure 4. International guidelines and recommendations for the treatment of type 2 diabetes mellitus (target levels of glycated hemoglobin) [21-26].
	Type	Исследовательские инструменты
	Date	2023-09-01
Digital Object Identifier	https://doi.org/10.14341/DM13079-6751

	Title	Figure 5. Individualized choice of therapy goals based on glycated hemoglobin (Russian clinical guidelines 2022 "Type 2 diabetes mellitus in adults") - do not apply to pregnant women [27].
	Type	Исследовательские инструменты
	Date	2023-09-01
Digital Object Identifier	https://doi.org/10.14341/DM13079-6752

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Diabetes mellitus

Early intensification of therapy for type 2 diabetes mellitus and achievement of the target level of glycohemoglobin HbA1c are necessary factors to reduce the risk of micro- and macrovascular complications