Abstract
Many studies have shown the importance of tight control of glycaemia in the primary prevention of cardiovascular (CV) mortality and morbidity. The effectiveness of glycemic control is increasing with the duration of treatment.
A kind of "glycemic memory" is present. Closer control of diabetes in the past results in a lower incidence of CV and microangiopathic complications, even after years of lower glycemic control.
Uncertainties about the importance of tight compensation of diabetes (below targets) in the secondary prevention of CV morbidity and mortality have been clarified this year. Very tight compensation of diabetes in patients with overt atherosclerosis was not reducing CV morbidity and mortality.
Low efficiency of tight compensation of diabetes may be caused by hypoglycaemia, which is a risk factor of CV morbidity. Close control of glycaemia was efficient in patients with short duration of diabetes, no manifest CV event and with a relatively good HbA1c value.
The authors of this article encourage efforts to achieve a very tight compensation of diabetes up to normal values in younger patients without CV complications. In the treatment they recommend maximum use of lifestyle modification, metformin treatment, as well as medicines that do not lead to hypoglycaemia, or have a low risk of hypoglycaemia occurrence.
Similar treatment tactics are appropriate for patients with diabetic nephropathy. Patients with advanced CV complications do not benefit from very tight control of glycaemia and this therapeutic approach may even increase CV morbidity and mortality.