10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2019

Abstract

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. For prevention and management of diabetes complications in children and adolescents, please refer to Section 13 "Children and Adolescents." Atherosclerotic cardiovascular disease (ASCVD)ddefined as coronary heart disease, cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origindis the leading cause of morbidity and mortality for individuals with diabetes and results in an estimated $37.3 billion in cardiovascular-related spending per year associated with diabetes (1). Common conditions coexisting with type 2 diabetes (e.g., hypertension and dyslipidemia) are clear risk factors for ASCVD, and diabetes itself confers independent risk. Numerous studies have shown the efficacy of controlling individual cardiovascular risk factors in preventing or slowing ASCVD in people with diabetes. Furthermore, large benefits are seen when multiple cardiovascular risk factors are addressed simultaneously. Under the current paradigm of aggressive risk factor modification in patients with diabetes, there is evidence that measures of 10-year coronary heart disease (CHD) risk among U.S. adults with diabetes have improved significantly over the past decade (2) and that ASCVD morbidity and mortality have decreased (3,4). Heart failure is another major cause of morbidity and mortality from cardiovascular disease. Recent studies have found that rates of incident heart failure hospitalization (adjusted for age and sex) were twofold higher in patients with diabetes compared with those without (5,6). People with diabetes may have heart failure with preserved ejection fraction (HFpEF) or with reduced ejection fraction (HFrEF). Hypertension is often a precursor of heart failure of either type, and ASCVD can coexist with either type (7), whereas prior myocardial infarction (MI) is often a major factor in HFrEF. Rates of heart failure hospitalization have been improved in recent trials including patients with type 2 diabetes, most of whom also had ASCVD, with sodiumglucose cotransporter 2 (SGLT2) inhibitors (8-10). For prevention and management of both ASCVD and heart failure, cardiovascular risk factors should be systematically assessed at least annually in all patients with diabetes. These risk factors include obesity/overweight, hypertension, d...

GLP-1 Receptor Agonists and Diabetic Kidney Disease: A Call of Attention to Nephrologists

“…Until recently, prevention of DKD progression was based on strict blood pressure (BP) control, using renin-angiotensin system blockers that simultaneously reduce BP and proteinuria, adequate glycemic control and control of cardiovascular risk factors (dyslipidemia, obesity and smoking), as well as nephrotoxic drug avoidance [6,8,9] (Table 1). This approach nonetheless results in significant residual renal and cardiovascular risk.…”

“…BP should be controlled with drugs that reduce cardiovascular events (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, thiazide-like diuretics or calcium channel blockers) [8]. However, despite the controversy surrounding target BP levels in T2DM patients, over 50% have BP <140/90 mmHg, but only around 20% have BP <130/80 mmHg [9].…”

Modifiable Factors Associated with Non-adherence to Antihypertensive or Antihyperlipidemic Drugs Are Dissimilar: a Multicenter Study Among Patients with Diabetes in Indonesia

“…4 Hypertension and hyperlipidemia are common in patients with diabetes and contribute significantly to an increased risk of CVD. 5 Therefore, antihypertensive and antihyperlipidemic co-medication is often necessary in diabetes patients. 5 Although antihypertensive and antihyperlipidemic drugs are fully covered by health insurance in Indonesia, medication adherence to these drugs is known to be suboptimal, 6 which may lead to poor health outcomes and increased healthcare costs.…”

“…5 Therefore, antihypertensive and antihyperlipidemic co-medication is often necessary in diabetes patients. 5 Although antihypertensive and antihyperlipidemic drugs are fully covered by health insurance in Indonesia, medication adherence to these drugs is known to be suboptimal, 6 which may lead to poor health outcomes and increased healthcare costs. 7 The risk of non-adherence to antihypertensive and antihyperlipidemic drugs is high due to the asymptomatic nature of these diseases, that is, the lack of noticeable efficacy by the patient in everyday life.…”

Factors affecting cardiovascular risk in patients with type 2 diabetes mellitus; a clinic based study No abstract available

“…A meta-analysis which was done in 2015 revealed lowering of blood pressure by 10mmHg was significantly lowered the cardiovascular events (23). American Diabetes association (ADA) recommends a goal of systolic pressure of 140mmHg and diastolic pressure of 90mmHg for treating diabetics with hypertension (24). This is an achievable target in a clinic.…”