The Cardiovascular and Macrovascular Benefits of Achieving Early Type 2 Diabetes Remission

Type 2 diabetes is a chronic non-communicable disease that has reached epidemic levels. While there is ample evidence that type 2 diabetes can, for many, be prevented or at least well managed, this disease progresses in most people with type 2 diabetes who are not achieving glucose targets. Those who do not achieve glucose targets have higher rates of microvascular and macrovascular complications. Further, the economic burden of diabetes, its treatment and its complications is substantial. Diabetes management goals should include prevention in those at risk and early intensive control to induce benefits through the legacy effect. However, what is seen more often is therapeutic inertia with delays in the diagnosis and each step of care. This results in reactive diabetes management in which the disease progresses faster than the management. While the use of newer potent glucose-lowering agents continues to expand, the durability of these agents when treatment is stopped is unknown. In this narrative review, the authors explore the impact of achieving diabetes remission on the reduction in cardiovascular complications.