Sitagliptin - Another option for managing type 2 diabetes in dialysis patients?

摘要

Type 2 diabetes is the predominant cause of end-stage renal disease, and cardiovascular disease (CVD) is the main cause of death in end-stage renal disease patients. Poststudy follow-up of patients with newly diagnosed type 2 diabetes from the UK Prospective Diabetes Study suggests that intensive versus conventional glucose control (achieved median hemoglobin A_(1c) [HbA_(1c)] of 7.0% vs 7.9%) can significantly reduce the long-term risks of myocardial infarction and all-cause mortality. However, more recent studies evaluating lower HbA_(1c) targets in patients with more long-standing type 2 diabetes and at high cardiovascular risk showed significant increases in severe and nonsevere hypoglycemia with intensive versus conventional treatment (achieved HbA_(1c) of 6.4%-6.6% vs 7.3%-8.4%). Importantly, intensive therapy did not reduce the risk of the primary cardiovascular composite end points compared to conventional treatment. Furthermore, the intensive therapy cohort from the ADVANCE (Action in Diabetes and Cardiovascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) study demonstrated an increased risk of cardiovascular and all-cause mortality that was not directly related to hypoglycemia. In sum, these trials seem to indicate that intensive treatment early in the course of type 2 diabetes may be the key to preventing macrovascular (ie, cardiovascular) complications.