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Microvascular complications are common in patients with type 2 diabetes mellitus. According to the results of recent studies (ADVANCE, VADT, ACCORD), achievement of glycemic control and blood pressure targets have only minor impact on microvascular complications. In 2005, the FIELD study showed that fenofibrate reduces the need for laser treatment of retinopathy and slows the progress of renal dysfunction. Furthermore, the FIELD eye sub-study concluded that fenofibrate reduces the risk of retinopathy and its progression. A later analysis of the FIELD study concluded that fenofibrate also reduces the risk of non-traumatic amputation in patients with diabetes. The ACCORD study produced similar results, showing that fenofibrate use significantly reduced the progression of retinopathy and albuminuria, independently of its effect on lipids. The results of these studies confirm the important role of fenofibrate in the prevention of significant microvascular diabetic complications. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2D) is a major public health concern, with high morbidity, mortality, and health-care costs. Studies have shown that subjects with T2D may also have obstructive sleep apnea (OSA). OSA is a risk factor for cardiovascular disease and mortality and it is associated with alterations in glucose metabolism which increase the risk of development of T2D. Studies in humans and animals have shown that the intermittent hypoxia and reduced sleep duration due to sleep fragmentation that characterize OSA have adverse effects on glucose metabolism. Both these conditions can induce a cascade of pathophysiological events, including autonomic activation, alterations in neuroendocrine function and release of potent proinflammatory mediators, such as tumor necrosis factor-α and interleukin- 6. The epidemiological and experimental evidence linking sleep apnea and T2D are reviewed and discussed here. [ABSTRACT FROM AUTHOR]

This review paper summarizes currently available data on the development of newer categories of antidiabetic agents, their ways of action and their clinical importance. During recent years significant achievements have been made in this field, including the development of SGLT2 inhibitors and glucokinase activators. The role of the metabolism of free fatty acids and bile acid in the treatment of diabetes mellitus is also reviewed [ABSTRACT FROM AUTHOR]

Glucagon-like peptide-1 (GLP-1) is involved in satiety control and glucose homeostasis. Besides, GLP-1 has cardiovascular effects. In experimental models, GLP-1 increases cardiac output and exerts a direct vasodilatory effect. In animals with dilated cardiomyopathy GLP-1 improves left ventricular performance. Human data demonstrated that GLP-1 reduces arterial blood pressure, improves endothelial function in individuals with diabetes and left ventricular function in patients with heart failure. Administration of GLP-1 increases ejection fraction in acute myocardial infraction and reduces ischemia-reperfusion myocardial injury. Although more research is needed, these data suggest that GLP-1 may be used with promising results in patients with heart failure, acute myocardial infarction and revascularization procedures in addition to the standard therapy.

A 3-year study assessed the prevalence and causes of severe treatment-related hypoglycaemia in type 2 diabetes mellitus patients admitted to hospital in Piraeus. Out of the 2858 patients admitted, 207 (7.2%) had severe hypoglycaemia: 72 were being managed with insulin, 132 oral hypoglycaemic drugs and 3 combined insulin/oral drugs. Only 28.5% of patients were attending a diabetes clinic. The cause of the hypoglycaemic attack could be determined for 86.1% of cases; 30.8% were due to a missed meal. Interviews showed that education and level of knowledge about diabetes mellitus, and particularly hypoglycaemia symptoms, was inadequate. Logistic regression analysis showed that knowledge about diabetes mellitus correlated with educational status and with follow-up in a diabetes clinic.