Diabetes Update: Prevention and Management of Diabetes Complications

Macrovascular complications of diabetes include cardiovascular events, whereas common microvascular complications include neuropathy, retinopathy, and diabetic kidney disease. Control of hypertension and dyslipidemia is an important step in minimizing the risk of complications. Blood pressure (BP) levels should be maintained at less than 140 mm Hg systolic and less than 90 mm Hg diastolic. In older adults, medical therapy to reduce BP to less than 130/70 mm Hg is not recommended. In these patients, a systolic BP level less than 130 mm Hg has not been shown to improve atherosclerotic cardiovascular disease (ASCVD) outcomes, and a diastolic BP less than 70 mm Hg is associated with a higher mortality risk. Patients with diabetes and a history of ASCVD should be treated with high-dose statins. A combination of ezetimibe and a moderate-dose statin is an option for patients who cannot tolerate high-dose therapy. Screening for kidney disease should be performed using estimated glomerular filtration rate and urine albumin measurement. Clinicians should be familiar with the limitations of both methods. Whether patients with diabetes are at increased risk of concomitant depression is not well understood, although a link has been shown in large, observational studies.