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Controversies in the cardiovascular management of type 2 diabetes
  1. Lionel H Opie1,
  2. Derek M Yellon2,
  3. Bernard J Gersh3
  1. 1Hatter Cardiovascular Research Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, South Africa
  2. 2The Hatter Cardiovascular Institute, University College London Hospital and Medical School, London, UK
  3. 3Mayo Clinic College of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Professor Derek M Yellon, The Hatter Cardiovascular Institute, University College London Hospital and Medical School, 67 Chenies Mews, London WC1E 6HX, UK; d.yellon{at}ucl.ac.uk

Abstract

In patients with type 2 diabetes mellitus, intense control of blood pressure, lipids and glucose, aiming at theoretically ideal values, is bought at a cost. Intense blood pressure control has renal complications. Intense lipid control, thus far, has worked for reduction of low-density lipoprotein-cholesterol, paradoxically at the cost of a small increase in new diabetes. Intense control of glycaemia generally requires insulin added to oral agents, which is consistently accompanied by weight gain, while increased hypoglycaemia has a long-term risk of cerebral damage. Intense glycaemic control has not consistently reduced mortality, whereas a strategy based on tight control of lipids and blood pressure with modestly tight glucose control has succeeded. Looking to the future, incretin mimetics may come to the fore as prime agents because they can reduce weight and glycaemia with little significant hypoglycaemia, thereby making tight glucose control easier to achieve.

  • Diabetes
  • hypertension
  • lipids
  • metabolic syndrome

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Footnotes

  • Competing interests None to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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