The future of people with type 2 diabetes, redefined by innovative therapeutic approaches


People with type 2 diabetes will benefit from a new approach to treatment, which has been defined by an international guide recently adopted by the American and European diabetes associations and which focuses on prevention, from the earliest stages of treatment. of cardio-renal complications.

The latest international guide in the field – the consensus of American and European companies (ADA-EASD 2018) – recognizes type 2 diabetes (type 2 diabetes) as a multifactorial condition, in which the treatment must aim from the beginning, in addition to glycemic control, and the early prevention of cardio-renal complications.

To achieve these goals, new classes of therapies are positioned as the first choice treatment in this condition.

The rising prevalence of diabetes is one of the most important public health issues globally. Moreover, it is estimated that the actual number of people affected could be almost double what we know, because the symptoms appear relatively late in the course of the disease.

“At the end of last year, worldwide, the number of patients with diabetes was somewhere over 400 million. It is important that in Romania the prevalence of diabetes is somewhere around 12 percent, which means that out of 10 adults, one has diabetes, “he says prof. dr. Romulus Timar, president of the Romanian Society of Diabetes, Nutrition and Metabolic Diseases, adding: “It is also important that, for every person who knows he has diabetes and is undergoing treatment, there is another person who may have diabetes, but does not know he has, or has diabetes and is not being treated. “

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People with type 2 diabetes have a two to three times higher risk of developing cardiovascular disease (CV) than the rest of the population, and these are the main cause of death in diabetes, the percentage being 50-80%.

Preventing cardiovascular complications is therefore a priority both for reducing mortality and the debilitating complications of diabetes, and for reducing the impact of this condition on society.

Conventional treatment for type 2 diabetes focuses on lowering blood sugar levels at certain target levels in the patient’s development. The risk of these patients developing cardiovascular complications, such as heart failure, whose mortality at five years is 50%, has led to a growing interest of the medical community in identifying therapies that ensure the best treatment of the factors involved in the evolution. disease and the installation of complications.

In addition to good glycemic control, the patient must also benefit from a treatment that ensures cardiovascular and renal protection, without omitting the control of lipids and blood pressure, as well as the observance of the diet and physical effort and quitting smoking.

New drug classes – SGLT2 inhibitors and GLP-1 receptor agonists – have shown in long-term studies that they bring cardiovascular or renal benefits, beyond a simple reduction in blood sugar.

“There are new classes of drugs that can bring an extraordinary surplus of benefit. Through these classes we can prevent cardiovascular disease or, if it is already present, we can greatly reduce the adverse evolution of this complication, respectively cardiovascular disease,” he said. Prof. Dr. Gabriela Roman, president of the Romanian Federation of Diabetes, Nutrition and Metabolic Diseases.

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Moreover, the guide made by American and European diabetes specialists also recommends closer collaboration between specialists in the treatment of the patient with type 2 diabetes, so that the medical team can evaluate and control, from the first stages of treatment, the complications associated with this disease.

“What does collaboration between specialists mean? Specialists should gather together at the patient’s head, not send the patient from one specialist to another, as unfortunately often happens. That is, each must come with the contribution of his specialty to an approach that more multifaceted, an approach of the patient’s accuracy.

Diabetes, cardiology, nephrology, of course therapeutic education, vascular surgery, orthopedics for the diabetic foot – this should be the team that approaches a patient with DM2, “he said. Prof. Dr. Cristian Serafinceanu, professor at UMF Carol Davila.

However, the prevention of diabetes and, in case of its diagnosis, the beginning of the treatment in the shortest possible time remains of great importance.

“It’s like when a house catches fire – it’s important to put out the fire when it appears, when it’s small. Firefighters come in vain when the house burns and you have nothing to save. So it is with patients with type 2 diabetes. It is to be detected early, it is important for patients to be aware of the importance of their condition, to respect what they are told about nutrition, to avoid sedentary lifestyle and to follow appropriate treatment, as recommended by the specialist, “he said. prof. dr. Romulus Timar.

Risk factors for cardiovascular disease largely overlap with risk factors for diabetes, draws attention Prof. Dr. Gabriela Roman.

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“Where does this risk come from? (…) It is very much based on an unhealthy lifestyle”, which includes an inadequate diet in terms of quantity and quality, with increased consumption of fat and sugar, weight gain and lack of physical activity.

To prevent the onset of diabetes, the most important measures are the adoption of a healthy lifestyle“What it means to eat what we should, when we should, how much we should and how we should”, insists Prof. Dr. Romulus Timar.

As shown by the results of the largest study with CV objectives – which enrolled over 17,000 patients with type 2 diabetes and CV risk – the prevention of heart failure or the progression of kidney disease, by using a inhibitor SGLT2 Before any of these complications, it is a great opportunity to reduce morbidity and mortality in this category of patients, as well as reduce the social and economic impact of type 2 diabetes on society.

The results of the consensus adopted by European and American specialists could become visible over time.

“Finally, in five years, in ten years, if we are to make an assessment of the cardiovascular diseases that have appeared in those with diabetes, we could see with great joy that in fact there is a reduction of 30-40 percent, maybe even 50 percent of this pathology “, he adds Prof. Dr. Gabriela Roman.

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