New approaches to the old disease

A five-year international study showed that ongoing intensive care for diabetics is more effective than the standard one — accepted worldwide.

We are talking about the study ADVANCE (Action in Diabetes and Vascular Disease: Preterax and MR Controlled Evaluation – Controlled study on diabetes and vascular pathology) involving patients with type 2 diabetes from 20 countries, including Russia.

Diabetes of the second type (insulin-independent) usually develops in old age and is dangerous in lesions of blood vessels, which, in turn, lead to damage to the kidneys, retina, and other pathologies. The researchers of the ADVANCE project took the path of intensive control of blood pressure (BP) and sugar level (glucose) in blood serum for the prevention of vascular complications of diabetes. Doctors used a combination therapy based on two new drugs – to regulate pressure and reduce HbA1c, the level of glycated hemoglobin, which normally should not exceed 6%.

In total, 11,140 patients in 215 clinical centers of the world aged 55 years and older who were at high risk of developing complications took part in the study. The mean arterial pressure in the subjects was 145/81 mm Hg. The control group of patients was treated with standard therapy.

A positive result was a significant reduction (by 21%) in the risk of nephropathy, from which every fifth patient with type 2 diabetes dies. On average, HbA1c was achieved at 6.5%. The researchers note that intensive glycemic control significantly reduces the overall risk of severe complications by 10%, and the risk of proteinuria (urinary protein excretion), one of the important indicators of high cardiovascular risk, is reduced by 30%.

The researchers emphasize that a decrease in HbA1c to 6.5% is safe in terms of the development of hypoglycemia (low blood sugar), which can lead to sudden death.

As told during a press conference in RIA-Novosti, the head of the department of endocrinology at the Moscow Medical Academy named after I.M. Sechenov Academician of the Russian Academy of Sciences Ivan Dedov, in another study conducted almost simultaneously with ADVANCE, its organizers attempted to reduce the HbA1 indicator to 6% in a short time (6 months), i.e. to normal. They succeeded in this, but at the same time the mortality of patients increased 3 times as compared with patients undergoing standard therapy. The reason was the development of severe hypoglycemia, which forced the collapse of the study 18 months after they began.

Academician Dedov cited WHO data on the incidence of diabetes, according to which there are now 246 million patients in the world. By 2025, as expected, their number will grow to 380 million people and will amount to 7.1% of the adult population of the planet. The disease is most common in the countries of the Eastern Mediterranean and the Middle East, where the incidence of diabetes reaches 9.2% of the population. Recently, the second type of diabetes – the disease of the elderly – is increasingly common in children. Doctors consider obesity and a sedentary lifestyle one of the most important risk factors for its development.

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