[The importance of rehabilitation with cardiovascular diabetic patients after surgical interventions]

Patients with diabetes nowadays are not directly endangered by dysglycemia, but they suffer vascular complications. The diabetic patient with existing cardiovascular (CV) disease has a particularly high risk for further CV complications and, therefore, requires specific attention. These patients need an intense and multimodal therapeutic approach which includes a strong interdisciplinary cooperation between the cardiologist and the diabetologist. Cardiac rehabilitation can effectively improve prognosis of CV patients with numbers needed to treat (NNT) comparable to standard pharmacological treatment. In diabetics, after coronary surgery, metabolism frequently and markedly deteriorates, and this requires strict metabolic monitoring and close cooperation between the diabetes team and the other professionals (cardiologist, nurses, physiotherapists, psychologists . . .) to reduce complications arising from hyperglycemia and also hypoglycemia and to improve the CV risk factors by lifestyle changes. Frequently, diabetes is only diagnosed during the hospital stay for CV complication; therefore, in these patients, specific attention is required for teaching and inauguration of therapy. Due to the high risk of these patients and the need of qualified metabolic co-treatment, following CV surgery, diabetic patients should be treated preferentially in rehabilitation centres specialised in both cardiac and metabolic care. Recent studies indicate that a multimodal and aggressive approach in CV diabetic patients can markedly improve their prognosis.