3 | Its advantages
Since T2D is as dangerous as coronary heart disease and associates with higher MACCE, which include cardiovascular and non-cardiovascular hospitalizations, AMI, CHF, ischemic stroke/TIA recurrence, and death [79], abnormal glycemic levels link to high mortality and morbidity. For example, on the one hand, maternal T2D highly links to arterial stiffness, cardiac hypertrophy, and congenital heart defects; On the other hand, there is increasing T2D in offspring in late adult life due to maternal gestational hypertension. Thus, we think that there are obvious advantages of this iRT-ABCDEFG for T2D, which will help to realize the European Society of Cardiology’s ambitious mission “to reduce the burden of CVD” in countries worldwide [80].
Most cases of new onset T1D in China occurred among adults [81], this iRT-ABCDEFG program is suitable for not only T2D but also T1D because it can help to decrease and delay onset of T1D by healthy E(e)SEEDi lifestyle and cutting a genetic pathway in the early stage of one’s lifetime due to control of maternal risks. Thus, this iRT-ABCDEFG program is worthy of conducting in the globe. In addition, since T2D is surprisingly closely linked to AMI, CHF, and stroke, diabetic chronic kidney disease (CKD), maximum effort must be made to control the prevalence of T2D so as to halt CVD and its costs increasing. Since policy initiatives can help controlling increases in health care spending [82], it’s time for not only Health in All Policiesbut also Health in All Laws [16,83].
With the further studies on mechanisms and the continuing development of new drugs and novel technologies for T2D, more precise and effective management or self-management of T2D with this iRT-ABCDEFG program is possible due to the role of structure-editing on unhealthy lifestyle [84], and long-term trends in mortality and the incidence of MACCE will also decline. For example, a clinical trial confirmed that oral insulin 338 can safely improve glycaemic control in insulin-naive patients with T2D, although it isn’t in place of subcutaneous insulin glargine yet due to being not commercially viable at current stage [85].
In short, since some cardiovascular metabolic factors of T2D, such as obesity, physical inactivity, obstructive sleep apnea (OSA), hypertension, and other modifiable unhealthy E(e)SEEDi lifestyle-related factors, may induce MACCE (AF, AMI, CHF, Stroke) and reduce health span and life span[86,87], control and prevention of these risk factors according to this iRT-ABCDEFG program will get more clinical benefit and improve cardiovascular outcomes. The SGLT2 inhibitors and GLP-1 receptor agonists, the newer classes of antihyperglycemic agents with the cardiorenal protective effects [88], will add distinctly clinical benefit. The MRA finerenone also reduces the composite kidney and cardiovascular outcomes [89].