Role specifique du controle glycemique dans la prevention de l'angiopathie du patient diabetique de type 2.

Even if type 2 diabetes is a complex disease combining hyperglycaemia and various other metabolic abnormalities. Reduction of chronic hyperglycemia, assessed by glycated haemoglobin (HbA1c), allows the prevention or the delay of vascular complications. Evidence-based medicine already provided numerous data regarding the risk of microangiopathy, especially retinopathy and nephropathy but also neuropathy. The evidence is less obvious as far as macroangiopathy, especially coronary artery disease, is concerned. This observation should encourage a global approach of the type 2 diabetic patient, taking into account all vascular risk factors. It also provides further arguments in favour of alternative therapeutic modalities, such as the use of hypoglycaemic agents that improve postprandial hyperglycaemia and/or insulin resistance. This latter approach appears to be promising in view of the favourable results with metformin in the United Kingdom Prospective Diabetes Study. It should be confirmed in large prospective ongoing clinical trials with new insulin sensitizers like thiazolidinediones.