Page 194 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology Medication therapy based on HbA1c

1. Introduction In addition to antihyperglycemic medications,
the use of cardiovascular drugs in managing IHD in
Type 2 diabetes mellitus (T2DM) and ischemic heart diabetic patients is important. Previous studies emphasize
disease (IHD) are among the most prevalent chronic the necessity of integrating antihypertensive therapy,
conditions worldwide, posing significant challenges particularly angiotensin-converting enzyme (ACE)
to healthcare systems due to their high morbidity and inhibitors, angiotensin receptor blockers, and beta-blockers,
mortality rates. The International Diabetes Federation into diabetes care. Intensive glycemic control is linked to
9,10
estimates that the global prevalence of diabetes will reduced cardiovascular and renal complications. 11-13 Most
continue to rise, reaching alarming levels by 2030. of these studies used structured clinical data, such as HbA1c
1
Whiting et al. provided global estimates of diabetes levels, blood pressure, lipids, creatinine, and demographic
1
prevalence, highlighting the significant burden of DM and variables, to construct predictive models of treatment
its complications. This increase underscores the urgent efficacy or complication risk. 14-16 The data are usually used
need for effective management strategies to mitigate the
associated health risks. to train linear and logistic regression models, but recent
works incorporate machine learning and metabolomic data
Patients with T2DM are particularly vulnerable to to refine risk stratification. 17-21
cardiovascular diseases, including IHD, due to the complex In addition, economic and systemic factors were
interplay between hyperglycemia, insulin resistance, also considered in diabetic management. Beran et al.
22
and cardiovascular risk factors. The United Kingdom
Prospective Diabetes Study (UKPDS) highlighted conducted a cost-effectiveness analysis of expanding
2
the critical role of blood-glucose control in reducing access to newer antidiabetic medications in low- and
cardiovascular complications among patients with T2DM. middle-income countries, revealing that these therapies
23
Achieving target glycated hemoglobin (HbA1c) levels is can be viable if priced appropriately. Nelson et al.
a cornerstone of diabetes management, as it significantly focused on the gaps in therapy adherence among insured
lowers the risk of cardiovascular events. United States patients with T2DM and cardiovascular
disease, highlighting the discrepancy between guideline
HbA1c level serves as a reliable marker for long-term recommendations and real-world practice. These findings
glycemic control, reflecting average blood glucose levels underscore the broader systemic and socioeconomic
over the past 2 – 3 months. The American Diabetes challenges that influence therapeutic outcomes.
Association recommends maintaining HbA1c levels below
7% to minimize the risk of diabetes-related complications. 2. Methodology
However, individual targets may vary based on patient 2.1. Patient selection and data collection
characteristics, comorbidities, age, and treatment goals.
Older adults with complex health conditions or intermediate This study was performed at the Republican Specialized
health are advised to reach target levels of HbA1c below Scientific-Practical Medical Center of Cardiology in
8%. Similarly, the Action to Control Cardiovascular Risk Uzbekistan from 2022 to 2024. A total of 130 patients
3
in Diabetes study analyzed the trajectory of HbA1c and previously diagnosed with T2DM and IHD were
its impact on cardiovascular outcomes, emphasizing the included in this study. The inclusion criteria for patients
importance of maintaining optimal glycemic control. 4 with T2DM were established according to the World
Health Organization classification: (i) Patients with a left
Medications used for glycemic control include sodium-
glucose co-transporter 2 (SGLT2) inhibitors and glucagon- ventricular ejection fraction (LVEF) ≥50%, and (ii) patients
with T2DM and heart failure with LVEF between 41% and
like peptide-1 (GLP-1) receptor agonists, and metformin. 49%.
5-8
The results of previous studies demonstrated that SGLT2
inhibitors significantly reduced the risk of major adverse Patients were excluded if they had any of the following
cardiovascular events, heart failure hospitalization, and conditions: (i) A recent myocardial infarction (<3 months
all-cause mortality; their combined use with GLP-1 ago), (ii) chronic heart failure of New York Heart Association
receptor agonists is more effective than monotherapy. class III – IV, (iii) severe liver and kidney dysfunction,
Metformin remains a cornerstone in T2DM management (iv) respiratory failure, (v) significant arrhythmias, and
due to its proven efficacy in lowering HbA1c and reducing (vi) heart failure with LVEF ≤40%. Patients with lower levels
cardiovascular risk, as first demonstrated by the UKPDS. of LVEF were excluded because they received a different
Insulin therapy is reserved for patients with suboptimal treatment regimen in accordance with national standards of
control despite oral medication, a pattern reflected in both care in Uzbekistan, which could affect clinical outcomes and
the literature and the current study’s findings. the extent of change in measured indicators.

Volume 9 Issue 3 (2025) 186 doi: 10.36922/EJMO025160133