[What has changed in the therapeutic strategy for type 2 diabetes mellitus?]

Abstract

Diabetes mellitus is a rapidly evolving area of medicine with the publication of new studies, the introduction of new drugs and a proliferation of clinical practice guidelines, often with subtle differences in the recommended therapeutic approach to patients with this disease. Notable among the extensive information generated on the disease in the last few years is evaluation of the studies with greatest impact on clinical practice in terms of defining glycemic targets and the preferred therapeutic strategy to achieve them. After the disappointing results of intensive glucose control in most patients revealed in the ACCORD, ADVANCE and VADT trials, recent data from the extensions of the UKPDS and STENO-2 trials have shown a new emphasis in the treatment of the disease, highlighting the importance of treatment and optimal glycemic control in the early stages. This strategy confers a long-term benefit on morbidity and mortality through a new concept which has become known as "metabolic memory" or the "legacy effect". Recently introduced drugs with action on the incretin system have been shown to have pleiotropic effects beyond their already confirmed effect on glycemic control, which could lead to their use becoming prioritized in the future. In view of these contributions, both through clinical trials and through data obtained with the new therapies, the overall management of diabetes should be modified. This need for modification is reflected in some of the most recent updates of clinical practice guidelines that incorporate some of these advances.