Treatment of diabetes mellitus: Implications of the use of oral agents
Cardiovascular mortality rates are high in patients with type 2 diabetes, in part a result of the high prevalence of cardiovascular risk factors in this population of patients. Because there is evidence that endogenous insulin may be atherogenic, treatment of patients with type 2 diabetes and insulin resistance syndrome with agents that reduce endogenous insulin levels and have beneficial effects on serum lipids may protect these patients against cardiovascular death and morbidity. Evidence shows that metformin, troglitazone, and acarbose are effective at lowering FPG and glycosylated hemoglobin levels and may have favorable effects on some cardiovascular risk factors such as hypertension and dyslipidemia. Clinical trials are needed to test the cardiovascular effects of these insulin-sparing agents and to evaluate their efficacy with regard to mortality rates and the incidence of microvascular and macrovascular complications of type 2 diabetes. Glimepiride is a new sulfonylurea that is effective at lowering FPG and glycosylated hemoglobin with-once-daily dosing. Clinical trials are also needed to delineate the cardiovascular effects of this new agent. As yet, no studies have examined the effect of any of these agents on reducing retinopathy, nephropathy, neuropathy, peripheral vascular disease, myocardial infarction, stroke, and/or death.
Rao, SV; Bethel, MA; Feinglos, MN
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