Glycaemic control in comorbid patients: an important element of CVD progression prevention

Abstract

There is a clear and specific bidirectional relationship between diabetes mellitus and cardiovascular disease. It is known that cardiovascular disease in patients with diabetes occurs 2–5 times more often than in people without diabetes. CVD itself, and it is cardiovascular outcomes, are the main cause of death in patients with diabetes mellitus, both in men and women. In diabetes mellitus, there is a high risk of coronary heart disease, myocardial infarction, arterial hypertension, and acute cerebrovascular accident, and patients with diabetes may experience painless acute myocardial infarction associated with the presence of autonomic cardiac neuropathy. Much more often in diabetes mellitus there are various rhythm disturbances, including paroxysmal forms of atrial fibrillation, which increase the risk of death by 1.8–2 times. Currently, numerous international clinical studies have convincingly demonstrated that improved glycemic control causes a significant reduction in the risk of late macroand microvascular complications of diabetes mellitus. The concept of dysglycemia includes disorders of glycated hemoglobin (HbA1c), fasting glycemia, postprandial glycemia, hypoglycemia, and glycemic variability. Dysglycemia increases the risk of developing type 2 diabetes mellitus and cardiovascular diseases, and their poor prognosis. HbA1c is the “gold standard” for monitoring glycemic control, but this indicator does not provide complete information about daily and intraday changes in glucose levels. Variability (not level) of fasting glucose determines cardiovascular mortality in patients with type 2 diabetes mellitus. Achieving glucose stability may become an additional therapeutic goal for the management of this category of patients with diabetes mellitus, and low glycemic variability is currently assessed as an additional target. Algorithms of specialized medical care for patients with diabetes mellitus recommend that patients with type 2 diabetes mellitus carry out self-monitoring, depending on the type of treatment taken and the degree of carbohydrate metabolism compensation. An important aspect of the technical impact on the adherence of patients to self-control and treatment of diabetes mellitus is the availability of convenient communication between the patient and the doctor, in particular, the possibility of contact remotely via a computer and mobile phone. In conclusion, the possibilities of a new model of the Contour® glucometer line, the Contour® Plus One glucometer, are considered.