Diabetes mellitus is called the plague of the 20th century. This disease, widespread in the Western world, affects more and more people every year. Diabetes mellitus is the most important risk factor for the development and progression of cardiovascular pathologies. Two-thirds of people with diabetes die from some form of cardiovascular disease.

There are two types of diabetes mellitus:

The first type is juvenile diabetes. The disease, as a rule, develops in the early years of life, is associated with insufficient insulin secretion by the pancreas and is treated with the administration of insulin preparations.

The second type of diabetes is usually diagnosed over the age of 30. The mechanism of its development is not based on the production of insulin, but on the reduced sensitivity of tissues to it. Blood sugar levels in these patients are mainly regulated by diet, exercise, and medication. Typically, patients with the second type of diabetes are overweight, have high blood pressure and impaired blood cholesterol metabolism.

Diabetes mellitus is dangerous with complications. Heart disease is twice as common in people with diabetes, and cardiovascular complications, including premature death, occur at an earlier age. The mechanism of damage to the heart vessels in diabetes mellitus is not fully understood. However, coronary artery disease (a disease associated with acute or gradual blockage of the heart vessels) has its own pronounced characteristics. In many cases, the disease is asymptomatic and by the time of diagnosis it is far from advanced.

In diabetes mellitus, as a rule, all major cardiac vessels are diffusely affected at once. Acute myocardial infarction is characterized by higher mortality and more frequent development of heart failure.

Current treatment of coronary artery disease through balloon dilatation of the heart vessels and stent placement is less successful in diabetic patients compared to non-diabetic patients, because it is accompanied by a more frequent development of re-constriction.

Coronary artery bypass grafting is accompanied by a higher surgical mortality and a shorter duration of the grafts.

People with diabetes mellitus have a 2-4 times higher risk of cerebrovascular accidents, and 2-4 times more often these disorders occur again.

Diabetes mellitus is the leading cause of blindness in people between the ages of 20 and 74, and the most common cause of kidney failure, up to and including complete kidney failure. Most people on dialysis or undergoing kidney transplant surgery have diabetes.

Diabetes mellitus also damages large vessels, disrupting, first of all, blood circulation in the lower extremities. Thus, the risk of leg amputation in patients with vascular damage on the background of diabetes mellitus is 30 times higher than in patients without diabetes. Damage to the peripheral nervous system, a tendency to infection, impotence – this is another incomplete list of those problems that may arise in patients with diabetes.

The key to successful treatment of diabetes mellitus is in realizing the seriousness of the problem. It is necessary to constantly monitor and control a number of indicators, such as blood sugar, urine protein, blood pressure, cholesterol, pulse, weight, electrocardiogram, fundus, etc.

Particular importance in patients with diabetes mellitus is drawn to the correction of blood pressure. This indicator, along with the level of protein in the blood, is an important predictor of renal function. The optimal pressure is considered to be lower than 130/80 mmhg.

What indicators in patients require correction of drug treatment? For example, a decrease in glucose on an empty stomach is less than 80 mg / dl or an increase of more than 300 mg / dl. “Red flags” for a patient with diabetes mellitus are acute hunger, accompanied by hot sweat and a feeling of loss or loss of consciousness, dry mouth, profuse urination against the background of long-term uncorrelated blood sugar levels. All these signs require urgent medical attention.

A sharp decrease in the amount of urine excreted, chest pain, shortness of breath, sudden severe headache, loss of orientation, loss of consciousness, difficulty in speaking, weakness in the limbs, acute changes in vision, pain in the limbs, accompanied by a cold snap, also require immediate medical attention as well as the appearance of inflammatory infiltrates or abscesses on the skin, prolonged temperature.

People with diabetes can reduce the risk of complications by fulfilling practical and necessary requirements: smoking cessation, moderate exercise, proper nutrition, weight control. Weight loss alone can be sufficient to stabilize blood glucose levels. In any situation, effective weight loss can reduce the amount and dosage of drugs needed for treatment, and therefore reduce the risk of side effects.

Physical activity improves insulin sensitivity and decreases blood glucose levels, trains the cardiovascular system, and has a positive psychological effect.

The choice of the treatment regimen for diabetes mellitus is the prerogative of the doctor, and the success of treatment depends to a large extent on the interaction of both links of the “doctor – patient” axis. A feature of the disease is the high dynamics in changes in blood sugar levels, a wide profile of possible complications and the hidden nature of clinical manifestations.

The patient can make the treatment process more effective by incorporating daily clinical introspection and varying the treatment within the framework established by the doctor. This can be a change in the doses of drugs used depending on the level of sugar in the blood or a special procedure in case of going beyond the boundaries indicated by the doctor. Active patient participation requires a high degree of motivation and medical awareness.

The remedies used for treatment are varied and have two main interrelated goals.

The first is the maximum normalization of blood glucose levels. The criteria are a decrease in HbA1c less than 7 (an integral indicator reflecting the average blood glucose level in the last 2 to 3 months), and periodically measured glucose levels in the range of 80 – 120 mg / dl.

The drugs of the second drug groups are widely used for the treatment of diabetes mellitus.

The first is GLP-1 agonists (Victoza, Trulicity, Ozempic) effectively lower glucose levels, relatively rarely cause hypoglycemia, reduce weight and improve cardiovascular prognosis.

SGLT2 inhibitors (Jardiance, Farxiga, Suglat) intensively excrete glucose in the urine, do not cause hypoglycemia, reduce the patient’s weight and reduce the risk of cardiovascular death.

The second is the prevention and treatment of complications of diabetes. For this purpose, various means of protecting the renal function, stabilizing fat metabolism, and normalizing blood pressure are used.

Patients should pay attention to unexpected swelling, redness of the skin. Oral and body hygiene can protect against microbial infections that diabetes patients are so prone to.