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J Clin Outcomes Manage
2008 Mar;15(3):133-146
Cardioprotective strategies for patients with Type 2 diabetes
Trikudanathan S, McMahon GT
Abstract Objective: To review evidence-based measures for reducing cardiovascular (CVD) risk in patients with diabetes. Methods: Review of the literature. Results: Most patients with diabetes will require at least 1 oral hypoglycemic drug, and almost all will ultimately require insulin. Until further data emerge, the most appropriate initial choices remain metformin and a sulfonylurea, moving to metformin and long-acting insulin when glycemic control is suboptimal on maximal dose therapy. Almost all patients should be treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. In the absence of contraindications, 81 mg of aspirin should be given to all patients with diabetes who are age 40 or older. For patients with diabetes whose lipids are not at target range, nonpharmacologic interventions (diet and exercise) remain first-line therapies. Lowering low-density lipoprotein cholesterol is the first priority in treating diabetic dyslipidemia. Statins are the agents of first choice, followed by fibrates or ezetimibe. Conclusion: CVD should be a primary concern for patients with type 2 diabetes and the physicians who care for them. Clinicians need to be sensitive to the challenges these patients face in making therapeutic lifestyle changes and be adept at navigating the polypharmacy that follows from targeting multiple CVD risk factors.
Case-Based Review, CME
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