Journal of Diabetes & Metabolism
Open Access

Residual Microvascular Risk in Type 2 Diabetes in 2014: Is it Time for a Re-Think? A Perspective from the Residual Risk Reduction Initiative (R3i)

Michel P Hermans^1*, Jean-Charles Fruchart², Jean Davignon³, Khalid Al-Rubeaan⁴, Pierre Amarenco⁵, Gerd Assmann⁶, Philip Barter⁷, John Betteridge⁸, Eric Bruckert⁹, M John Chapman¹⁰, Ada Cuevas¹¹, Michel Farnier¹², Ele Ferrannini¹³, Paola Fioretto¹⁴, Jacques Genest¹⁵, Henry N Ginsberg¹⁶, Antonio M Gotto Jr¹⁷, Dayi Hu¹⁸, Takashi Kadowaki¹⁹, Tatsuhiko Kodama²⁰, Michel Krempf²¹, Yuji Matsuzawa²², Jesús Millán Núñez-Cortés²³, Carlos Calvo Monfil²⁴, Hisao Ogawa²⁵, Jorge Plutzky²⁶, Daniel J Rader²⁷, Željko Reiner²⁸, Shaukat Sadikot²⁹, Raul D Santos³⁰, Evgeny Shlyakhto³¹, Piyamitr Sritara³², Rody Sy³³, Alan Tall³⁴, Chee-Eng Tan³⁵, Lale Tokgözoglu³⁶, Peter P Toth³⁷, Paul Valensi³⁸, Christoph Wanner³⁹, Alberto Zambon¹⁴, JunRen Zhu⁴⁰and Paul Zimmet⁴¹

¹Clinical university St-luc, Brussels, Belgium

²R3i Foundation, St. Alban-Anlage 46, Basel, Switzerland

³Clinical Research Institute of Montreal Montreal University Health Center and Department of Experimental Medicine, McGill University, Montreal, Canada

⁴University Diabetes Center, King Saud University, Riyadh, Saudi Arabia

⁵Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France

⁶Assmann Foundation for Prevention, Germany

⁷Centre for Vascular Research, University of New South Wales, Sydney, Australia

⁸University College London, London, UK

⁹Endocrinology and Cardiovascular Disease Prevention, Hospital Pitié-Salpêtrière, Paris, France

¹⁰University of Pierre and Marie Curie, INSERM Dyslipidemia and Atherosclerosis Research Unit, Hospital Pitié-Salpêtrière, Paris, France

¹¹Nutrition Center, Clínica Las Condes, Santiago, Chile

¹²Point Medical, Dijon, France

¹³University of Pisa School of Medicine, and Metabolism Unit of the National Research Council (CNR) Institute of Clinical Physiology, Pisa, Italy

¹⁴Department of Medical and Surgical Sciences, University of Padova, Padova, Italy

¹⁵McGill University and Center for Innovative Medicine, McGill University Health Center/Royal Victoria Hospital, Montreal, Canada

¹⁶Department of Medicine and Irving Institute for Clinical and Translational Research, Columbia University, New York, USA

¹⁷Weill Cornell Medical College, Cornell University, New York, USA

¹⁸Hospital of Peking University, Beijing, China

¹⁹Diabetes and Metabolic Diseases Unit, University of Tokyo, Japan

²⁰Department of Systems Biology and Medicine, University of Tokyo, Japan

²¹Human Nutritional Research Center and Department of Endocrinology, Metabolic diseases and Nutrition, University Hospital Nantes, Nantes, France

²²Sumitomo Hospital and Osaka University, Osaka, Japan

²³University Hospital Gregorio Marañón, Madrid, Spain

²⁴University of Concepción, Concepción, Chile

²⁵Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, and National Cerebral and Cardiovascular Center, Osaka, Japan

²⁶Brigham and Women’s Hospital and Harvard Medical School, Boston, USA

²⁷Division of Translational Medicine and Human Genetics, Smilow Center for Translational Research, Penn Cardiovascular Institute, Philadelphia, Pennsylvania, USA

²⁸Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Croatia

²⁹Jaslok Hospital and Research Center, Mumbai, India

³⁰Director of Clinical Unit of Lipids InCor- HCFMUSP, Sao Paulo, Brazil

³¹Federal Almazov Heart Blood Endocrinology Centre, St Petersburg, Russia

³²Mahidol University, Bangkok, Thailand

³³University of the Philippines-Philippine General Hospital, Manila, The Philippines

³⁴Specialized Center of Research (SCOR) in Molecular Medicine and Atherosclerosis, Columbia University, College of Physicians & Surgeons, New York, USA

³⁵Gleneagles Medical Centre, Singapore

³⁶Hacettepe University, Ankara, Turkey

³⁷CGH Medical Center, Sterling, Illinois, and University of Illinois School of Medicine, Peoria, Illinois

³⁸Hospital Jean Verdier, Department of Endocrinology Diabetology Nutrition, AP-HP, Paris-Nord University, CRNH-IdF, CINFO, Bondy, France

³⁹University Hospital Würzburg, Würzburg, Germany

⁴⁰Zhongshan Hospital, Fudan University, Shanghai, China

⁴¹Baker IDI Heart and Diabetes Institute, Melbourne, Australia

*Corresponding Author:

Michel P Hermans, MD PhD
Dip Nat Sci Dip Earth Sci Dip Geog Env PG Cert (SocSc)
Endocrinology & Nutrition, UCL 54. 74 Tour
Claude Bernard +1, avenue Hippocrate 54
B 1200 Brussels, Belgium
Tel: +32 27645475
Fax: +32 27645418
E-mail: [email protected]

Received date: July 22, 2014; Accepted date: August 11, 2014; Published date: August 19, 2014

Citation: Hermans MP, Fruchart JC, Davignon J, Al-Rubeaan K, Amarenco P, et al. (2014) Residual Microvascular Risk in Type 2 Diabetes in 2014: Is it Time for a Re-Think? A Perspective from the Residual Risk Reduction Initiative (R3i). J Diabetes Metab 5:413. doi: 10.4172/2155-6156.1000413

Copyright: © 2014 Hermans MP, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Microvascular complications associated with type 2 diabetes, including diabetic retinopathy, nephropathy and neuropathy, account for much of the societal burden of diabetes. Even with effective multifactorial intervention, targeting glycemia, blood pressure and lowdensity lipoprotein cholesterol, in addition to lifestyle intervention, a high residual microvascular risk persists. The Residual Risk Reduction Initiative (R3i) highlights two key priorities for reducing this residual risk. First, there should be optimal management of cardiometabolic risk factors, including atherogenic dyslipidemia, elevated triglycerides and low plasma high-density lipoprotein cholesterol, to improve lipid goal attainment. Second, consistent evidence from two major trials may merit consideration of adjunctive fenofibrate therapy to slow progression of diabetic retinopathy in type 2 diabetes patients with pre-existing disease. These data provide a strong rationale for testing in a prospective study. The R3i strongly believes that addressing both priorities is critical to reducing the substantial residual risk of microvascular complications in type 2 diabetes.

• Microvascular
• residual
• risk
• Type
• diabetes
• Diabetic
• retinopathy
• Diabetic
• nephropathy
• Atherogenic
• dyslipidemia
• Prevention
• Guidelines