Diabetes Mellitus: An Update

It is well established that diabetes mellitus is actually a multisystem disease responsible for a great burden of morbidity and mortality globally since it causes several cardiovascular complications; macro as well as micro-vascular [1]. This attitude is mainly attributed to the fact that these patients show a high risk for the development of atherosclerotic lesions for various causes such as hyperglycaemia, dyslipidemia and insulin resistance, resulting in impaired platelet function, endothelial, vascular smooth muscle cell dysfunction and abnormal coagulation [2]. Therefore it is easily assumed that individualized treatment strategy is needed and for that cause stratification of cardiovascular risk among these patients has become a necessity. As a result, several models have been developed over the last decades which highlighted specific risk factors for developing cardiovascular disease including age more than 40 years, male gender, history of relative suffering from premature CHD, blood pressure and high LDL levels, presence of microalbuminuria or obstructive sleep apnea [3].

Taking all the above mentioned into account, researchers concluded that efficient management of cardiovascular risk is in fact a critical component of diabetes care. Kyriakos et al. reviewed clinical trials and concluded that this medication is showed to be effective in lowering the risk of cardiovascular disease without burden the renal function [4]. In addition, a new group of hypoglycemic drugs has been used to treat diabetes type 2.; the active sodium glucose co-transporter (SGLT2) or SGLT2 inhibitors. It has been shown that besides the treatment of diabetes, this drug class is responsible for the mildness of the cardiovascular events shown in patients with diabetes type 2 [5]. However, there are controversial data regarding the existence of a class effect [6].

Many scientific committees strongly recommend the incretin-based therapies, dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon- like peptide 1 (GLP-1) receptor agonists, as an option for add-on therapy to first-line therapy with metformin or other antidiabetic medications [7, 8].

Finally, we should not forget to mention a new pivotal intervention in the effective management of diabetes mellitus and its severe complications. Bariatric surgery including procedures like Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, Laparoscopic Adjustable Gastric Banding as it is summarized by Damaskos et al. [9, 10]. This approach improves clinically appropriate endpoints that include the remission of various comorbidities and the lowering of cardiovascular risks together with serious cardiovascular events but the emphasis should be given on appropriate patient selection with a long-term period of follow-up [11].

In conclusion, diabetes mellitus is undoubtedly a complex disease. The purpose of this thematic issue is to highlight the new therapeutic approaches like incretin-based therapies, the SGLT2 inhibitors and the bariatric procedures.