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This review describes results of some basic large clinical trials on glucose lowering therapy directed on a prevention of macro- and microvascular complications of diabetes mellitus type 2. Authors emphasize that the results of these trials in relation to efficacy of modern glucose lowering therapy in terms of macrovascular complications prevention and decrease of mortality of patients with diabetes mellitus type 2 are so controversal. Taking into account the limited efficacy of glucose lowering therapy, basic question is it macrovascular safety, and also maximal removal of side effects, namely increase of risk of hypoglycemia and weight gain. From point of efficacy and safety, both in monotherapy and in the combined treatment, metformin advantageously differs from other glucose lowering preparations. The new algorithm for glucose lowering therapy based on the use of drugs that do not increase the risk of hypoglycemia and do not increase the weight has significant advantages compared to the traditional approach.
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