Consider kidney, heart disease in type 2 diabetes treatment
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Type-2 diabetes affects approximately 90% of the estimated 463 million people diagnosed with diabetes worldwide. One of the concerning fact is that about 79 million adults who are 20 years of age or older have Prediabetes. Prediabetes is defined as a glycosylated haemoglobin (HbA1c) level ranging from 5.7% to 6.4%and is at risk for the disease.

Primary care providers are well-positioned to help patients with type 2 diabetes to achieve glycaemic control along with reducing their risks for serious complications such as atherosclerotic cardiovascular disease, heart failure and chronic kidney disease.

Recent outcomes of the trials of glucagon-like peptide 1 receptor agonists and sodium– glucose co-transporter 2 inhibitors have revealed that these agents offer cardio-renal benefits along with their glucose-lowering effects. The American Diabetes Association and the European Association for the Study of Diabetes now recommend person-centred approach to type 2 diabetes treatment through which a patient’s multimorbidities, preferences, characteristics, and barriers are considered alongside with A1C in individualizing the diabetes management plan. Research has demonstrated the potential benefits from primary through tertiary prevention of micro- and macro-vascular disease while also achieving glycaemic targets.

Although tight glucose control is essential for improving outcomes in type-2 diabetes mellitus, research data highlights the importance of non-glucose goals. Patients with longstanding type-2 diabetes may already have complications; therefore, tight blood glucose management in this population might not provide the same degree of benefits compared with newly diagnosed type-2 diabetes and may be detrimental in patients at risk for hypoglycaemia.Targeting non-glucose goals is especially important in this population in order to improve patient outcomes.

Achievement of non-glucose goals improves outcomes. Controlling hypertension in patients with type-2 diabetes can reduce the progression of cardiovascular disease (CVD) and the risk of micro vascular complications (i.e., retinopathy, nephropathy, and neuropathy).Similarly, dyslipidaemia confers a greater risk of CVD and is highly prevalent in patients with type-2 diabetes. It is well established that controlling dyslipidaemia reduces the risk of CVD-related complications. Clinicians should emphasize not only an attainment of glucose goals but also non-glucose goals in order to optimize outcomes.