Cardiovasc Prev Pharmacother.  2024 Oct;6(4):116-122. 10.36011/cpp.2024.6.e15.

Paradigm shift from glucocentric to organ protection for the management of hyperglycemia in patients with type 2 diabetes

• Lee JE
• Won JC

• KMID: 2560383
• DOI: http://doi.org/10.36011/cpp.2024.6.e15

Abstract

The UK Prospective Diabetes Study was the first study to investigate the effectiveness of glycemic control in patients with type 2 diabetes. Since then, many studies have evaluated the impact of intensive glycemic control on diabetes-related morbidities and mortality. The results of these studies were intended to change the paradigm for controlling glycated hemoglobin and preventing diabetes-related complications, but the beneficial outcomes were limited to microvascular diseases rather than diabetes-related cardiorenal diseases and deaths. This has emphasized the need for comprehensive management of other risk factors (hypertension, dyslipidemia, renal failure, etc.) in addition to hyperglycemia to prevent atherosclerotic cardiovascular diseases and end-stage renal disease in type 2 diabetes. Since 2008, clinical trials to demonstrate cardiovascular safety have shown a beneficial effect of sodium-glucose transporter 2 inhibitors or glucagon-like peptide-1 receptor agonists on macrovascular or renal complications in patients with type 2 diabetes. Recently, major societies around the world including the Korean Diabetes Association, have shifted the goals of diabetes management from the typical glucocentric view to cardiorenal outcome-oriented (organ protection) care, which has been widely accepted and is gradually applied to primary care.

Keyword

Diabetes mellitus; Glucagon-like peptide-1 receptor agonists; Sodium-glucose transporter 2 inhibitors; Diabetic cardiomyopathies; Diabetic nephropathies

Figure

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  Fig. 1. Paradigm shift of diabetes care from glucocentric to organ protection. UKPDS, UK Prospective Diabetes Study; ACCORD, Action to Control Cardiovascular Risk in Diabetes; ADVANCE, Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation; VADT, Veterans Affairs Diabetes Trial; EMPA-REG, Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Diabetes Mellitus Patients-Removing Excess Glucose; LEADER, Liraglutide Effect and Action in Diabetes; A1c, glycated hemoglobin; HF, heart failure; eASCVD, established atherosclerotic cardiovascular disease; CKD, chronic kidney disease. a)Major recommendations for choosing a glucose-lowering agent after diabetes education for lifestyle modification and initial treatment with metformin otherwise severe hyperglycemia in 2007, 2011, and 2021 (from left to right, Ko et al. [12], Ko et al. [26], and Hur et al. [34], respectively). Adapted from Won et al. [27], available under the the Creative Commons Attribution Non-Commercial License.

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