65% of diabetic deaths due to cardiovascular problems

65% of diabetic deaths are caused by cardiovascular problems
prevention and early treatment are the best recipes to prevent this disease that affects 250 million people

The 69th scientific sessions of the American Diabetes Association (ADA-2009) have concluded with a clear recipe to defeat that disease: prevention and early treatment.Improve lifestyle, especially with a healthy diet and physical exercise that avoids the great risk factor of obesity, and acting soon and firmly with the therapies available to lower plasma glucose, are the keys to curb the expansion ofThis global epidemic (the current 250 million affected will be 380 million in 2025) and to minimize complications, especially cardiovascular, which cause more than 65% of patient deaths.

If it is serious that the disease extends when it could be prevented in 80% of cases, just as disturbing is that their bad control in up to 75% of patients favor their progressive development and their serious health consequences.The difference between a well -controlled diabetic person by your doctor and another that is not20% less to the socio -health system.Or otherwise by British expert Stephen Gough: the single reduction of 1% of blood glucose decreases death by 21%, 31% microvascular complications and 14% macrovascular.

Costa complications
All these data support the early intervention strategy.
Especially when in countries like the United States, the highest cost of diabetes (83%) comes from their complications, while drugs represent 17%.For the 13,000 specialists gathered in New Orleans, action guidelines against the most common type 2 diabetes are already well established, with a first line of changes in lifestyle, complemented with a first oral antidiabetic, metformin, when the doctorconsider it necessary.In a second phase, new therapies will be added, some already very validated such as basal insulin and sulfonylureas, and others in full development, such as those based on the incredine -hormones that help process sugar in the body -, which have given riseto those known as DPP4 inhibitors and GLP-1 receptor agonists.

There are, therefore, more and more therapeutic options to choose from, and the most recent have confirmed in the studies presented in ADA-2009 its combined efficacy against diabetes and its complications.This is the case of Liraglutida, an analogue derived from LPG-1 that is about to be approved in Europe and that, as stressed by the Spanish specialist Eduard Montanya and the British David Matthews, reduces plasma glucose while lowering two factors ofRisk such as blood pressure and weight, improves the function of pancreatic cells, and achieves a good safety profile in terms of hypoglycemia.The drug has been airy of two comparative studies with a sulfonylurea, glymepirid, and with a GLP-1 recipient agonist, exenatted.

Clinical practice
But, in addition to looking at the therapies that come, ADA-2009 has placed special emphasis on clarifying concrete doubts about daily clinical practice.That is why he booked a hot topic for the last day, in which two studies on the 'cardiovascular issue' were reviewed last year caused great discussion.
The first, baptized as Accord, pointed out 20% more risk of death in an intensive therapy group (to lower the glucose of 7%), which fear that this approach could be dangerous.However, a more thorough analysis of allThe data has made it clear that reducing glucose decreases the risk of death, and that this danger grows as the level of blood sugar rises;According to the American Matthew Riddle, 20% more for each point above 6% glucose.
The second essay, Vadt, has now contributed the key to the contradictory result of Accord in 2008: the 'antiquity' of patients undergoing intensive therapy.

According to the American William Duckworth, start that radical treatment in type 2 diabetics diagnosed up to 15 years before, reduced the risk of cardiovascular and death episodes.But doing so in the diagnosis 16-20 years ago did not suppose that benefit.And even worse in diabetics with more than 20 years of illness, which saw more than duplicating those dangers.In general, and although the individualization of treatments is increasingly imposed, intensive therapy remains valid in the first 15 years after diagnosis, but should not begin when the patient has been with diabetes for more than 20 years.

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