Téma: Clinical pharmacology

Clinical trials in diabetology 2005

Ivan Tkáč

The results of two important studies investigating the effect of glycemic control on cardiovascular morbidity and mortality in patients with type 2 diabetes with present macrovascular disease were published in 2005. DIGAMI 2 study investigated the diabetes patients post acute myocardial infarction (AMI) with respect to their hospital treatment (insulin-glucose infusion), as well as posthospital treatment (intensified insulin regimens or conventional oral antidiabetic drug regimens). The level of glycemic control in all three examined groups was similar. DIGAMI 2 study did not show difference in the effect of individual treatment approaches on the mortality of diabetic patients after AMI. Worse glycemic control was associated with higher mortality rate. The main message of the study is that in post-AMI diabetic patients it is important to achieve the best possible glycemic control. The total mortality or incidence of cardiovascular events or strokes was not influenced by the way, how this glycemic control was achieved. In the PROactive study, the effect of add-on pioglitazone treatment on mortality and the incidence of cardiovascular events in type 2 diabetes patients with previous macrovascular disease was examined. Adding pioglitazone to the existing antidiabetic treatment non-significantly reduced the primary endpoint of the study, which was a composite of total mortality, incidence of coronary events, strokes or various vascular interventions. Main secondary endpoint, a composite of total mortality, non-fatal myocardial infarction and stroke incidence, was significantly reduced by 16 %. The results of the PROactive study not only indicate possible benefit of glitazones as add-on treatment to the currently used antidiabetic drugs in the prevention of macrovascular complications, but also showed decrease of newly initiated insulin treatment by 53 % in pioglitazone treated patients.

Ročník 2006  Témy časopisu Internal medicine 3 / 2006

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