Kardiovaskulärein der Therapie des Typ-2-Diabetes-mellitus

Summary Cardiovascular outcome studies in type 2 diabetes therapy Patients suffering from type 2 diabetes are at increased risk of cardiovascular disease. Unlike statins and antihypertensive drugs, few evidence based data exist on the effects of hypoglycaemic agents on mortality and cardiovascular endpoints. Five prospective controlled studies to date have examined endpoints such as microvascular complications, macrovascular diseases and mortality in type 2 diabetic patients. These studies are the University Group Diabetes Program (UGDP), the Kumamoto study, the United Kingdom Prospective Diabetes Study (UKPDS), the Steno-2 study, and recently the PROactive study. These studies show that rigorous lowering of blood glucose (independent from the type of medication – UKPDS), intensive (versus conventional) insulin therapy (Kumamoto) and especially multifactorial intensive treatment of all features of the metabolic syndrome (hypertension, obesity, dyslipoproteinemia) (Steno-2) are to varying degrees associated with a reduction of cardiovascular risk in type 2 diabetic patients. With the exception of metformin (UKPDS) and pioglitazone (PROactive), however, these studies do not show positive individual effects of the other hypoglycaemic agents on cardiovascular endpoints. This picture may change in the future, as further results from studies with new hypoglycaemic agents are expected.