Diabetes mellitus and cardiovascular diseases. An updated approach to lifestyle modification and treatment of patients with diabetes mellitus type 2

Background. The issue of optimal antihyperglycemic therapy choice presents essential, taking into consideration the increase of number of patients with diabetes mellitus (DM) type 2 and excessive mortality of these patients from cardiovascular diseases (CVD). The updated recommendations presented in consensus report of American Diabetes Association (ADA) in cooperation with European Association for the Study of Diabetes (EASD) in 2018 reflect complex approach to treatment of adult patients with DM type 2 that aims not only to improve glycemic control, but also to decrease CVD incidence and mortality. Materials and methods. In order to write this review we analyzed ADA/EASD consensus report of 2018 as well as Russian algorithms and recommendations on DM treatment and several foreign sources including 2008 documents from US Food and Drug Administration (FDA) and the documents from American Association of Clinical Endocrinologists (AACE) published over the past year. Results. A complex control of risk factors that includes patient’s lifestyle change and use of safe and effective medications that will contribute to lipid metabolism, arterial blood pressure and thrombocyte function normalization is required in order to reduce CVD risk and mortality in patients with DM type 2. Lifestyle modification is placed special focus on. It comprises patients’ encouragement and competence increase as well as development and implementation of an individualized program of nutrition intervention and patients’ physical activity increase. In patients with DM type 2 glycemia self-control is considered to be of great importance because it allows the trained patients to control the disease course much better. A favorable prognosis is possible only when complex individual approach is used. Conclusion. Despite development of new effective and safe medications, more than ½ of the patients do not reach glycemia target levels. Therapeutic inactivity, that is multifactorial, is of great significance. In order to cope with it efforts are required both from the whole health care system and from medical practitioners and patients themselves. Modern combined antihyperglycemic therapy that has effect on various pathogenic mechanisms and allows to level down glycemia variability and increase treatment compliance is quite actual. During all stages of DM type 2 treatment it is essential to bear in mind that multifactor and individualized approach is required in order to achieve long-term results.

diabetes mellitus type 2, lifestyle, patients’ education, structured education programs, non-pharmacological treatment methods, self-control, glucometers, antihyperglycemic agents, cardiovascular disease, chronic kidney disease, obesity