Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2013, vol. 22, nr 6, November-December, p. 777–784

Publication type: editorial article

Language: English

Controversies in Diabetes in 2013 – a Brief Update

Kontrowersje w leczeniu cukrzycy w 2013 roku – krótkie podsumowanie

Grzegorz Gajos1,D,E,F, Stanisław Piłaciński2,D, Dorota Zozulińska-Ziółkiewicz2,D,E

1 Department of Coronary Disease, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland

2 Department of Internal Medicine and Diabetology, Poznań University of Medical Sciences, Poland

Abstract

Incidence of diabetes is increasing worldwide at an alarming rate. Therefore, a proper understanding of the mechanisms and efficient treatment of the disease is becoming increasingly important. The article briefly describes controversies in type 1 diabetes (T1DM) pathogenesis and diagnosis (genetic background, accelerator hypothesis, new autoantibodies, new information on LADA – latent autoimmune diabetes in adults, and the role of TRAIL – tumor necrosis factor-related apoptosis-inducing ligand) and treatment (how to deal with fluctuations of blood glucose concentrations and the occurrence of hypoglycemia, the role of healthy lifestyle, especially physical exercise, and a proper diet, treatment of insulin resistance and the challenges in detecting diabetic neuropathy). Moreover, issues in the pathogenesis of macrovascular complications in type 2 diabetes (T2DM) are considered (novel risk factors – vascular hyperglycemic memory, hypoglycemia, altered profile of microRNAs expression, impaired function of vascular progenitor cells, altered fibrin clot properties and iron-induced blood coagulation). Modern treatment of T2DM, based on lifestyle intervention and antidiabetic drugs, is full of controversies and it seems that over time the number of uncertainties is constantly increasing. Recent trials have reported disappointing results in lifestyle intervention (LOOK-AHEAD) and antihyperglycemic treatment (ACCORD, SAVOR-TIMI 53, EXAMINE, concerns about sulfonylureas safety). Moreover, there are considerable deviations from treatment targets that are recommended by the guidelines (blood glucose, hypertension, blood lipids) in real-life clinical practice in patients at different stages of the disease development. It seems that beneficial modification of the natural history of diabetes is unlikely in the foreseeable future unless we are able to obtain a more in-depth understanding of the pathomechanisms of the disease

Streszczenie

Częstość występowania cukrzycy na świecie zwiększa się bardzo szybko. Dlatego coraz ważniejsze staje się odpowiednie zrozumienie mechanizmów i skuteczne leczenie tej choroby. W artykule w skrócie opisano kontrowersje w poglądach na patogenezę i diagnostykę cukrzycy typu 1 (podłoże genetyczne, hipoteza akceleratora, nowe przeciwciała, nowa wiedza o LADA – utajonej autoimmunologicznej cukrzycy u dorosłych i rola TRAIL – związanego z czynnikiem martwicy nowotworu ligandu wywołującego apoptozę) oraz leczenie (postępowanie z wahaniami stężenia glukozy we krwi, zapobieganie występowaniu hipoglikemii, rola zdrowego stylu życia, zwłaszcza aktywności fizycznej i odpowiedniej diety, leczenie insulinooporności, wykrywanie neuropatii cukrzycowej). Omówiono ponadto zagadnienia patogenezy powikłań makronaczyniowych cukrzycy typu 2 (nowe czynniki ryzyka – metaboliczna pamięć naczyniowa, hipoglikemia, zmiany profilu ekspresji mikroRNA, zaburzenia czynności naczyniowych komórek progenitorowych, zmiany właściwości skrzepu fibrynowego, zaburzenia krzepnięcia krwi wywołanego żelazem). Nowoczesne leczenie cukrzycy typu 2 z uwzględnieniem zmian stylu życia i stosowaniem leków przeciwcukrzycowych jest nadal przedmiotem kontrowersji i wydaje się, że liczba wątpliwości nadal wzrasta. Ostatnie badania dotyczące modyfikacji stylu życia (LOOK-AHEAD) i leków przeciwcukrzycowych (ACCORD, SAVORTIMI 53, EXAMINE, zastrzeżenia co do bezpieczeństwa pochodnych sulfonylomocznika) nie przyniosły oczekiwanych wyników dotyczących poprawy rokowania sercowo-naczyniowego. Co więcej, w codziennej praktyce klinicznej występują istotne różnice między osiąganymi celami terapeutycznymi a zaleceniami do praktyki klinicznej (stężenie glukozy we krwi, ciśnienie tętnicze, stężenie lipidów we krwi) we wszystkich stadiach rozwoju choroby. Wydaje się, że osiągnięcie korzystnej modyfikacji przebiegu klinicznego u chorych na cukrzycę jest mało prawdopodobne, jeżeli nie uda się bardziej szczegółowo poznać patomechanizmów choroby i jej powikłań

Key words

type 1 diabetes, type 2 diabetes, autoimmune diabetes, cardiovascular complications of diabetes.

Słowa kluczowe

cukrzyca typu 1, cukrzyca typu 2, cukrzyca o podłożu autoimmunologicznym, powikłania sercowo-naczyniowe cukrzycy.

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