Diabetes mellitus: relation between cardiovascular events and pharmacological treatment

Diabetes mellitus: relation between cardiovascular events and pharmacological treatment


  • Cláudio Santos University of Coimbra, Faculty of Pharmacy, Portugal; BIAL - Portela & C.ª , S.A, Porto, Portugal
  • Sónia Brito-Costa Polytechnic Institute of Coimbra, Institute of Applied Research (i2A): Human Potential Development Center (CDPH); Coimbra Education School, Research Group in Social and Human Sciences (NICSH) https://orcid.org/0000-0002-7074-887X
  • Luis Margalho Polytechnic Institute of Coimbra, Coimbra Engineering Institute, Department of Physics and Mathematics, Portugal
  • Pedro Monteiro University of Coimbra, Faculty of Medicine, Portugal


Diabetes mellitus, cardiovascular events, pharmacological treatment


Background and aim: Cardiovascular diseases are characterized by problems affecting the circulatory system, specifically the heart and blood vessels. This study evaluates the relationship between cardiovascular events and pharmacological treatment for Type II Diabetes Mellitus (T2DM). Methods: We recruited 227 individuals, 191 with T2DM (EG) and 36 pre-diabetics (CG), with a mean age of 70.3 years (SD=8.3), and 62 years (SD=10.3) respectively. The individuals were distributed into five groups concerning the following variables: body mass index (BMI), age, diagnosis age of T2DM, glycated hemoglobin value (HbA1c), Homeostatic model that estimates the function of β cells value (HOMA2-B), and Homeostatic model that estimates insulin resistance (HOMA-IR) value. At the time of data collection, there were no individuals with T1DM, so it was decided to use prediabetic individuals (with a high risk of developing T2DM). Results: Group 1 had the pre-diabetic patients (15.9%), while diabetic individuals were divided into groups 2 (1.8%), 3 (17.6%), 4 (21.1%) and 5 (43.6%). It was possible to conclude that most of the patients in the different groups had a history of acute myocardial infarction (AMI). Regarding the prevalence of pharmacological treatment, it was possible to conclude that metformin was the most used drug in most of the groups. Conclusions: It was possible to create different groups and to observe the existence of dependency relationships between different cardiovascular events and pharmacological treatment.


Hurtado MD, Vella A. What is type 2 diabetes? Med (United Kingdom). 2019;47(1):10-15.

Khawandanah J. Double or hybrid diabetes: A systematic review on disease prevalence, characteristics and risk factors. Nutr Diabetes 2019;9(33):1-9.

Cerf ME. Beta Cell Dysfunction and Insulin Resistance. Front Endocrinol 2013;4:1-12.

Chatterjee S, Khunti K, Davies MJ. Type 2 diabetes. Lancet 2017;389(10085):2239-2251.

Murea M, Ma L, Freedman BI. Genetic and environmental factors associated with type 2 diabetes and diabetic vascular complications. Rev Diabet Stud 2012;9(1):6-22.

Seuring T, Archangelidi O, Suhrcke M. The Economic Costs of Type 2 Diabetes: A Global Systematic Review. Pharmacoeconomics 2015;33(8):811-831.

Zhou B, Lu Y, Hajifathalian K, et al. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. Lancet 2016;387(10027):1513-1530.

Vos T, Abajobir AA, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390(10100):1211-1259.

Observatório Nacional da Diabetes. Diabetes: Factos e Números - O Ano 2015.; 2016

Katzung BG, Masters SB, Trevor AJ. Basic and Clinical Pharmacology. 14 edição. (The McGraw-Hill Companies, ed.) 2017

Davies MJ, D’Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the european association for the study of diabetes (EASD). Diabetes Care 2018;41(12):2669-2701.

American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2020. Diabetes Care 2020;43(Supplement 1):S98-S110.

Smeden M V., Harrell FE, Dahly DL. Novel diabetes subgroups. Lancet Diabetes Endocrinol 2018;6(6):439-440.

Ahlqvist E, Storm P, Käräjämäki A, et al. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Diabetes Endocrinol 2018;6(5):361-369.

Dennis JM, Shields BM, Henley WE, Jones AG, Hattersley AT. Disease progression and treatment response in data-driven subgroups of type 2 diabetes compared with models based on simple clinical features: an analysis using clinical trial data. Lancet Diabetes Endocrinol 2019;7(6):442-451.

Zaharia OP, Strassburger K, Strom A, et al. Risk of diabetes-associated diseases in subgroups of patients with recent-onset diabetes: a 5-year follow-up study. Lancet Diabetes Endocrinol 2019;7(9):684-694.

Zou X, Zhou X, Zhu Z, Ji L. Novel subgroups of patients with adult-onset diabetes in Chinese and US populations. Lancet Diabetes Endocrinol 2019;7(1):9-11.

Kahkoska AR, Geybels MS, Klein KR, et al. Validation of distinct type 2 diabetes clusters and their association with diabetes complications in the DEVOTE, LEADER and SUSTAIN‐6 cardiovascular outcomes trials. Diabetes, Obes Metab 2020:1-11.

Hewitt J, Castilla Guerra L, Fernández-Moreno MDC, Sierra C. Diabetes and Stroke Prevention: A Review. Stroke Res Treat 2012;2012:1-6.

Peters SAE, Huxley RR, Woodward M. Diabetes as a risk factor for stroke in women compared with men: A systematic review and meta-analysis of 64 cohorts, including 775 385 individuals and 12 539 strokes. Lancet 2014;383(9933):1973-1980.

Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes : a systematic literature review of scientific evidence from across the world in 2007 – 2017. Cardiovasc Diabetol 2018;17(83):1-19.

Leon BM. Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes 2015;6(13):1246-1258.

Uchasova E, Gruzdeva O, Shurygina, Dyleva Y, Belik E, Barbarash O. Insulin resistance and inflammation markers in myocardial infarction. J Inflamm Res 2013;6(1):83-90.

Seferović PM, Petrie MC, Filippatos GS, et al. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Faillure 2018;20(5):853-872.

Shah AD, Langenberg C, Rapsomaniki E, et al. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people. Lancet Diabetes Endocrinol 2015;3(2):105-113.

Ohkuma T, Komorita Y, Peters SAE, Woodward M. Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals. Diabetologia 2019;62(9):1550-1560.

Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart Journal 2018;39(33):3021-3104. doi:10.1093/eurheartj/ehy339.

Zoni-Berisso M, Domenicucci S. Epidemiology of atrial fibrillation : European perspective. Clin Epidemiol 2014;6:213-220.

American Diabetes Association. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2020. Diabetes Care 2020;43(Supplement 1):S111-S134.

Brito de Sá A, Oliveira C, Carvalho D, et al. Reuniões de Reflexão da Revista Portuguesa de Farmacoterapia A Diabetes Mellitus em Portugal : Relevância da Terapêutica Farmacológica Adequada. Rev Port Farmacoter 2016;8:44-53.

Chaudhury A, Duvoor C, Reddy Dendi VS, et al. Clinical review of antidiabetic drugs: Implications for type 2 diabetes mellitus management. Front Endocrinol 2017;8(6).

Marín-Peñalver JJ, Martín-Timón I, Sevillano-Collantes C, Cañizo-Gómez FJ del. Update on the treatment of type 2 diabetes mellitus. World J Diabetes 2016;7(17):354-395.

Yu O, Azoulay L, Yin H, Filion KB, Suissa S. Sulfonylureas as Initial Treatment for Type 2 Diabetes and the Risk of Severe Hypoglycemia. Am J Med 2018;131(3):317.e11-317.e22.

Filion KB, Douros A, Azoulay L, Yin H, Yu OH, Suissa S. Sulfonylureas as initial treatment for type 2 diabetes and the risk of adverse cardiovascular events: A population‐based cohort study. Br J Clin Pharmacol 2019;85(10):2378-2389.

Lebovitz HE. Thiazolidinediones: the Forgotten Diabetes Medications. Curr Diab Rep 2019;19(151):1-13.

Kalra S. Alpha-glucosidase Inhibitors. In: The Journal of the Pakistan Medical Association 2014; 64:474-476.

DiNicolantonio JJ, Bhutani J, O’Keefe JH. Acarbose: safe and effective for lowering postprandial hyperglycaemia and improving cardiovascular outcomes. Open Hear 2015;2(1):e000327.

Deacon CF. Physiology and Pharmacology of DPP-4 in Glucose Homeostasis and the Treatment of Type 2 Diabetes. Front Endocrinol 2019;10.

Gallwitz B. Clinical Use of DPP-4 Inhibitors. Front Endocrinol 2019;10:1-10.

Makrilakis K. The Role of DPP-4 Inhibitors in the Treatment Algorithm of Type 2 Diabetes Mellitus: When to Select, What to Expect. Int J Environ Res Public Health 2019;16(2720):1-20.

Husain M, Birkenfeld AL, Donsmark M, et al. Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2019;381(9):841-851.

Singh M, Kumar A. Risks Associated with SGLT2 Inhibitors: An Overview. Curr Drug Saf 2018;13(2):84-91.

Garofalo C, Borrelli S, Liberti ME, et al. SGLT2 inhibitors: Nephroprotective efficacy and side effects. Med 2019;55(6):1-13.

Martins A, Murteira R. Eficácia e Segurança dos Agonistas dos Recetores GLP-1 no Tratamento da Diabetes Mellitus Tipo 2: Revisão Sistemática. Rev Port Farmacoter 2016;(8):112-122.

Monteiro P, Aguiar C, Matos P, et al. Efeito da empaglifozina para além do controlo glicémico: benefício cardiovascular em doentes com DMT2 e doença cardiovascular estabelecida. Rev Port Cardiol 2019;38(10):721-735.

Direção-Geral da Saúde. Insulinoterapia na Diabetes Mellitus tipo 2. Norma da Direção-Geral da Saúde 2014:1-11.

Ashcroft FM, Rorsman P. Diabetes Mellitus and the β Cell: The Last Ten Years. Cell 2012;148(6):1160-1171.

Hendra TJ. Starting insulin therapy in elderly patients. J R Soc Med 2002;95:453-455.

Hesen NA, Riksen NP, Aalders B, Ritskes-hoitinga M, El S, Wever KE. A systematic review and meta-analysis of the protective effects of metformin in experimental myocardial infarction. PLoS One 2017;12(8):1-18.

Bromage DI, Godec TR, Rodriguez MP, et al. Metformin use and cardiovascular outcomes after acute myocardial infarction in patients with type 2 diabetes : a cohort study. Cardiovasc Diabetol 2019;18(168):1-9.

Wang M-T, Lin S-C, Tang P-L, et al. The impact of DPP-4 inhibitors on long-term survival among diabetic patients after first acute myocardial infarction. Cardiovasc Diabetol 2017;16(1):89.

Rossello X, Ferreira JP, McMurray JJ, et al. Impact of insulin-treated diabetes on cardiovascular outcomes following high-risk myocardial infarction. Eur Hear J Acute Cardiovasc Care 2019;8(3):231-241.

Packer M. Is metformin beneficial for heart failure in patients with type 2 diabetes? Diabetes Res Clin Pract 2018;136:168-170.

Crowley MJ, Diamantidis CJ, McDuffie JR, et al. Clinical Outcomes of Metformin Use in Populations With Chronic Kidney Disease, Congestive Heart Failure, or Chronic Liver Disease. Ann Intern Med 2017;166(3):191-200.

Cosmi F, Shen L, Magnoli M, et al. Treatment with insulin is associated with worse outcome in patients with chronic heart failure and diabetes. Eur J Heart Fail 2018;20:888-895.

Shen L, Rørth R, Cosmi D, et al. Insulin treatment and clinical outcomes in patients with diabetes and heart failure with preserved ejection fraction. Eur J Heart Fail 2019;21(8):974-984.







How to Cite

Diabetes mellitus: relation between cardiovascular events and pharmacological treatment . Acta Biomed [Internet]. 2023 Apr. 24 [cited 2024 May 22];94(2):e2023012. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/13685

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