The gravicentric Concept in type 2 Diabetes: practical implementation

Abstract

The epidemic rise of patients with type 2 diabetes mellitus (T2DM) worldwide continues, despite all efforts taken by the international medical community to curb it. It seems that the advent of new drugs does not contribute to a better control of the disease, the tightening up of diagnostic criteria causes an abrupt increase in the number of patients, while a revision of the main goals of treatment (a reduction of targets for glycemic control) often becomes an argument in favor of an overly aggressive approach to drug therapy in diabetes. The main therapeutic goal of existing algorithms for the management of T2DM patients is to achieve and maintain long-term indicators of glycemic control, as close to normal values as possible. However, almost none of these algorithms address the factors associated with the pathogenesis of development and progression of the underlying disease, such as lack of exercise and excessive adiposity. For the sake of achieving glycemic target values, patients often receive treatment that is known to be conducive to weight gain, insulin resistance and increased progression of relative insulin deficiency, eventually leading to the prescription of exogenous insulin. At the same time, an active modification of the pathogenetic factors of T2DM – excess body weight and physical inactivity – may lead to restoration of glucose tolerance, reducing the need of pharmacotherapy until its complete withdrawal, as has been shown in many major studies [2]. The "gravicentric concept" of treatment of T2DM is designed to redefine the basic therapeutic targets and change the emphasis in the of patients' management scheme. Its mission is to create a clear idea for both doctors and patients about the possibility of de-intensification of pharmacotherapy under certain conditions, and to focus maximum effort to address the factors of progression of the disease with the hope of a cure or remission