Researchers highlight need for paradigm shift in management of type 2 diabetes

Heart disease is a leading cause of death worldwide and exacerbated by type 2 diabetes, yet diabetes treatment regimens tend to focus primarily on blood sugar maintenance. This common approach to type 2 diabetes management can leave patients at risk for heart attack and stroke. But results from four recent randomized clinical trials suggest that using medications that offer glucose control while reducing the risk for cardiovascular disease could improve patient outcomes.

"Strong evidence provided by the four recent trials published within the past 1.5 to 2 years in the New England Journal of Medicine has shown that some of the modern available therapeutic agents that control blood glucose also help reduce the risk for cardiovascular disease," said Faramarz Ismail-Beigi, MD, PhD, Professor of Medicine at Case Western Reserve University and Endocrinologist at University Hospitals Cleveland Medical Center and Louis Stokes Cleveland VA Medical Center. "Based on this evidence, we propose that we must shift from our previous paradigm with its monocular focus on control of blood glucose and hemoglobin A1c, to one of control of blood glucose plus preventing cardiovascular disease and death from cardiovascular causes." Hemoglobin A1c is a common test used to determine a patient's average blood sugar levels over the previous 2-3 months.

Ismail-Beigi helped conduct three of the four clinical trials, and he and his collaborators recently reviewed trial results in the Journal of General Internal Medicine. The trials each tested a blood sugar-lowering medication-;pioglitazone, empagliflozin, liraglutide, or semaglutide-;but recruited patients with heart disease or stroke. The goal was to determine whether or not the drugs were safe, but in each study, researchers were surprised to find participants with or at risk of type 2 diabetes also experienced cardiovascular improvements.

"For the first time we have seen glucose-lowering medications that can improve cardiovascular outcomes," Ismail-Beigi said. "It is highly possible that newer agents in these classes of medications, used singly or in combination, will prove to be more efficacious in the management of type 2 diabetes and prevention of cardiovascular disease, even in patients at earlier stages of the disease process."

Previous studies focused on tight control of blood sugar have not shown major cardiovascular benefits for diabetes patients. "Strict control of blood glucose levels has shown minor, if any, positive effect on prevention of cardiovascular disease," said Ismail-Beigi. "In fact, a large NIH-funded clinical trial on type 2 diabetes management failed to show that strict control of blood glucose levels had any positive effect on cardiovascular outcomes or mortality, and in fact, may be harmful."

The new trial results could help address a major dilemma for clinicians looking for ways to control heart disease and reduce mortality, while simultaneously managing blood glucose in patients with type 2 diabetes.

Said Ismail-Beigi, "Our review focuses on the need for a paradigm shift on how we should think about management of type 2 diabetes. I believe it will necessitate a rethinking of goals and approaches by guideline committees. We also hope that the FDA might consider approving new medications for management of type 2 diabetes not only based on their safety profile and their efficacy to control blood glucose, but also whether the medication reduces overall mortality and cardiovascular-related mortality."


  1. Kelley Thibault Kelley Thibault United States says:

    These studies might show that controlling Type 2 blood glucose levels may have  no effect on heart disease and/or stroke and may actually contribute to those conditions? Drug companies over the past 20 years didn't know this? Or did and failed to mention that very important factor? Billions upon billions of dollars have been spent by patients trusting drug makers and doctors...for what? Hum...not to mention the potentially deadly side effects of these drugs, which are numerous. I'm Type 2 and allergic to many of the drugs used for diabetes. I refused insulin after reading the four, repeat FOUR, pages of known side effects in which they kept mentioning death! Wow! So, I did the research for over 2 years, started a regime of natural 'cell' boosters, enhancers that help my own body help myself, cut way back on all carbs, and then did more research...bottomline, the drug companies/doctors/researchers, don't have a clue what causes, contributes and continues to plague people with Type 2 diabetes.  It is so very complicated and you can't just put a bandaid on it and hope that works. So if the diabetes itself doesn't kill me, after the side effects of these drugs, the drugs themselves surely will. Each person with T2 is different, their metabolisms are different, lifestyles, eating habits, exercise habits, all come into play when dealing with diabetes. Don't believe the type, the 'unfinished' research studies. Trial and error with your own body is the only way to see what works for your individual system. Live life to the fullest, each and every day, enjoy your love ones and good luck!

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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