Guideline Approach to Therapy in Patients With Newly Diagnosed Type 2 Diabetes

Both the prevalence and incidence of type 2 diabetes are increasing worldwide in conjunction with increased Westernization of the population’s lifestyle. Type 2 diabetes is still a leading cause of cardiovascular disease (CVD), amputation, renal failure, and blindness. The risk for microvascular complications is related to overall glycemic burden over time as measured by A1C (1,2). The UK Prospective Diabetes Study (UKPDS) 10-year follow-up demonstrated a possible effect on CVD as well (3). A meta-analysis of cardiovascular outcome inpatientswith longdisease duration including Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) suggested that in these populations the reduction of ~1% in A1C is associated with a 15% relative reduction in nonfatal myocardial infarction (4). Most antihyperglycemic drugs besides insulin reduce A1C values to similar levels (5) but differ in their safety elements and pathophysiological effect. Thus, there is a need for recommending a drug therapy preference. While the positive effects on prevention of microvascular complications were demonstrated with the various antihyperglycemic drugs (1,2,6,7), several questions are left open regarding this therapy in newly diagnosed type 2 diabetes: