Treating the diabetic patient: appropriate care for glycemic control and cardiovascular disease risk factors

Diabetes, a leading cause of morbidity and mortality in the United States, is associated with a 2- to 4-fold increase in the risk of coronary artery disease. As the population in the United States has aged, the incidence of obesity, hypertension, glucose intolerance, and dyslipidemia has increased significantly, culminating in the current epidemic of type 2 diabetes mellitus. Strict glycemic control must, therefore, be accompanied with proven therapies (such as antihypertensives and lipid-lowering agents) to reduce cardiovascular events. Patients with type 2 diabetes have average low-density lipoprotein (LDL) levels but have an increased number of small, dense LDL particles, which are associated with a 3-fold increase in cardiovascular disease. Type 2 diabetes mellitus is also associated with increased triglyceride rich atherogenic particles, which trigger inflammation. In addition to glycemic control and drug therapy, lifestyle modifications (eg, diet, weight loss, and exercise) also play an important role in managing diabetes. Therefore, strict glycemic control, pharmacologic therapy, and lifestyle modifications are parts of a comprehensive strategy to prevent both microvascular and macrovascular events in patients with type 2 diabetes.