New perspectives in type 2 diabetes, cardiovascular risk, and treatment goals.

Diabetes mellitus is a complex and increasingly common metabolic disease that is characterized by hyperglycemia and associated with microvascular and macrovascular complications. Approximately 90% of patients with diabetes have type 2 diabetes. Obesity and type 2 diabetes are intricately linked, with weight gain being a major contributor to the increasing incidence of type 2 diabetes. Both conditions are independent risk factors for cardiovascular disease, which is the cause of death for the majority (65%) of patients with diabetes. Data from recent large-scale outcomes trials continue to clarify the role of glucose-lowering therapy for patients with type 2 diabetes and increased risk of cardiovascular disease. This serves to further underscore the importance of an individualized treatment approach that takes duration of disease, presence of complications and comorbidities, and the potential adverse risks of therapy into consideration. Although the currently available antidiabetes medications are effective in lowering glucose, some of these agents, including insulin, sulfonylureas, and thiazolidinediones, are often limited by weight gain and/or hypoglycemia. Expert panel guidelines recommend a comprehensive approach that targets the traditional risk factors (glucose, weight, blood pressure, lipids) as the ideal treatment strategy to prevent complications of type 2 diabetes. Incretin-based therapies, including the glucagon-like peptide-1 receptor agonists, target the fundamental defects of type 2 diabetes, reduce glycosylated hemoglobin and body weight, and have potentially beneficial effects on blood pressure, lipids, and other surrogate markers, leading to reduced cardiovascular risk. Physicians should be encouraged to adopt a therapeutic approach with individualized patient goals. By reinforcing the role of patients with type 2 diabetes in treatment decisions, better compliance and achievement of treatment goals can be achieved.