Jose Mario F. De Oliveira
Universidade Federal Fluminense, USA
Title: Targets for Diabetes Treatment in Children, Adolescents, Adults and the Incidence of Cardiovascular Disease. What Are We Missing?
Biography
Biography: Jose Mario F. De Oliveira
Abstract
In both type 1 and type 2 diabetes, cardiovascular diseaseas are the leading causes of morbi-mortality in both infancy, adolescense, and adulthood. And this is proved nowaday by a increasing number of new epidemiological data which shows an increase in the risk of cardiovascular events. The evidence from earlier trials have demonstrated that improvement in glycated haemoglobin will reduce the risk of micro vascular disease but there is lack of robust evidence to suggest whether improvement in glycaemic control will have similar beneficial outcomes on macro vascular disease. Also, despite all controversies surrounding the etiology, pathogenesis, and therapeutic role for hyperglycaemia in the mostly common form of diabetes, type 2 diabetes mellitus, newer anti-hyperglycaemic drugs are still getting onto the market at a high speed, due to the confidence in HbA1c as a surrogate outcome for microvascular complications; albeit all large recent randomised clinical trials and meta-analysis have shown that trying to achieve glycaemic levels close to the normal range did not reduce the most clinically important microvascular or macrovascular hard endpoints as end-stage renal disease, vision loss, amputations, strokes, fatal myocardial infarctions, heart failure, cardiovascular and total mortalities, with the added harm of substantial increase in the number of hypoglycaemic episodes. In summary, cardiovascular diseases are stil the number one cause of mortality for both type 1 and type 2 diabetes, independent of blood glycaemic levels of control, and wwe do not know the reasons for that, being probably multifactorial.