Diabetes mellitus type 2 secondary prevention
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Diabetes mellitus type 2 Microchapters |
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Differentiating Diabetes Mellitus Type 2 from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
The most important aspect of secondary prevention in diabetes mellitus type 2 is to decrease the mortality from macrovascular complications. Among the preventive measures, lipid control, smoking cessation, treatment of hypertension and regular ophthalmologist visit in order to prevent retinopathy are the most important ones.
Secondary Prevention
- Secondary prevention is focused on decreasing the macrovascular complications. Application of effective strategies can result in up to 50% risk reduction in macrovascular complications.[1]
- Effective measures in this case include:[2]
- Glycemic control
- Treatment of lipid disorders
- Triglyceride level should be less than 150 mg/dL (1.7 mmol/L)
- Favorable HDL levels is >40 mg/dL (1.0 mmol/L) for men and >50 mg/dL (1.3 mmol/L) for women.
- Statin treatment for preventive measures should be considered for all diabetic patients. The following table summarizes the statin therapy strategies:
Abbreviations:
CVD: Cardiovascular disease
| Age | Risk factors | Recommended statin dose† |
|---|---|---|
| <40 years | None
CVDrisk factor(s)¶ Overt CVDΔ |
None
Moderate or high High |
| 40 to 75 years | None
Overt CVD |
Moderate
High High |
| >75 years | None
Overt CVD |
Moderate
Moderate or high High |
† :In addition to lifestyle therapy.
¶ :CVD risk factors include LDL cholesterol ≥100 mg/dL (2.6 mmol/L), high blood pressure, smoking, and overweight and obesity.
Δ :Overt CVD includes those with previous cardiovascular events or acute coronary syndromes.
- Blood pressure control[3][4][5][6][7]
- Blood pressure should be measured on every visits. Goal of blood pressure in diabetic patient is less than 140/90.
- The Heart Outcomes Prevention Evaluation (HOPE) study suggested that the angiotensin-converting enzyme inhibitor ramipril could reduce vascular disease and mortality among patients at increased risk. This effect was thought to be independent of control of blood pressure. However, subsequent studies have shown this result was more likely due to the administration of ramipril at night and recording blood pressure during the day when the least effect of ramipril was present.
- Microvascular disease complications. Clinical practice guidelines[8] by the American Diabetes Association in 2019 stated to avoid diabetic complications:
- The ADA recommends “Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes."
- The ADA recommends “Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis.”
- The ADA recommend that “If there is no evidence of retinopathy for one or more annual eye exam and glycemia is well controlled, then exams every 1–2 years may be considered."
- The ADA recommend that “If any level of diabetic retinopathy is present, subsequent dilated retinal examinations should be repeated at least annually by an ophthalmologist or optometrist.
- The ADA recommend that “If retinopathy is progressing or sight-threatening, then examinations will be required more frequently
- Using Aspirin
- Weight reduction [9]
- Vaccination including, annual influenza, pneumococcal vaccination and hepatitis B.
- Regular dental care
References
- ↑ Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O (2003). "Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes". N. Engl. J. Med. 348 (5): 383–93. doi:10.1056/NEJMoa021778. PMID 12556541.
- ↑ Saydah SH, Fradkin J, Cowie CC (2004). "Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes". JAMA. 291 (3): 335–42. doi:10.1001/jama.291.3.335. PMID 14734596.
- ↑ Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G (2000). "Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators". N Engl J Med. 342 (3): 145–53. PMID 10639539.
- ↑ Sleight P, Yusuf S, Pogue J, Tsuyuki R, Diaz R, Probstfield J; et al. (2001 Dec 22-29). "Blood-pressure reduction and cardiovascular risk in HOPE study". Lancet. 358 (9299): 2130–1. doi:10.1016/S0140-6736(01)07186-0. PMID 11784631. Check date values in:
|year=(help) - ↑ "Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators". Lancet. 355 (9200): 253–9. 2000. PMID 10675071.
- ↑ Svensson P, de Faire U, Sleight P, Yusuf S, Ostergren J (2001). "Comparative effects of ramipril on ambulatory and office blood pressures: a HOPE Substudy". Hypertension. 38 (6): E28–32. PMID 11751742.
- ↑ Kurtz TW (2003). "False claims of blood pressure-independent protection by blockade of the renin angiotensin aldosterone system?". Hypertension. 41 (2): 193–6. PMID 12574079.
- ↑ American Diabetes Association (2019). "6. Glycemic Targets: Standards of Medical Care in Diabetes-2019". Diabetes Care. 42 (Suppl 1): S61–S70. doi:10.2337/dc19-S006. PMID 30559232.
- ↑ Anderson JW, Konz EC (2001). "Obesity and disease management: effects of weight loss on comorbid conditions". Obes Res. 9 Suppl 4: 326S–334S. doi:10.1038/oby.2001.138. PMID 11707561.