Abstract
Diabetes mellitus presents a significant public health burden based on its increased morbidity, mortality, and economic cost. The high comorbidity and prevalence of concomitant diseases like hypertension and dyslipidemia in diabetic patients cause the high risk in developing secondary, cost intensive, and for the patient often disastrous late complications (nephropathy, retinopathy, neuropathy, and cardiovascular disease). Therefore, patients with diabetes mellitus need a global risk management that takes the various individual clinical problems into account. The current global standards of therapy in patients with diabetes mellitus are focused on the control of glycemia, blood pressure, and lipid levels, as well as aspirin therapy and avoiding of smoking. There are a number of guidelines and recommendations to manage these global issues. Our review will summarize current recommendations and consolidate therapeutic goals and treatments that are of vital importance in the global risk management in diabetic patients.
Key words
Type 2 diabetes mellitus - hypertension - dyslipidemia - diabetes guidelines - cardiovascular risk management
References
-
1
Adler A I, Stratton I M, Neil H AW, Yudkin J S, Matthews D R, Cull C A, Wright A D, Turner R C, Holman R R.
Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study.
BMJ.
2000;
321
412-419
-
2
Alberti G.
A desktop guide to type 2 diabetes mellitus. European Diabetes Policy Group 1998 - 1999 International Diabetes Federation European Region.
Exp Clin Endocrinol Diabetes.
1999;
107
390-420
-
3
Alvarsson M, Steen L, Sundkvist G, Westermark G, Lager I, Westermark P, Henricsson M, Örn T, Berntrop K, Grill V, Fernquist-Forbes E.
Beneficial effects of insulin versus sulphonylurea on insulin secretion and metabolic control in recently diagnosed type 2 diabetic patients.
Diabet Care.
2003;
26
2231-2237
-
4
American Diabetes Association .
Aspirin therapy in diabetes (Position statement).
Diabet Care.
2003;
26
S87-S88
-
5
American Diabetes Association .
Aspirin therapy in diabetes.
Diabet Care.
2000;
23
S61-S62
-
6
American Diabetes Association .
Diabetes management in correctional institutions.
Diabet Care.
2004 a;
27
S114-S121
-
7
American Diabetes Association .
Hypertension management in adults with diabetes.
Diabet Care.
2004 b;
27
S65-S67
-
8
American Diabetes Association .
Management of dyslipidemia in adults with diabetes.
Diabet Care.
2002;
25
S74-S77
-
9
Armitage J.
Lipid-lowering trails in diabetes.
Eur Heart J.
1999;
1
M13-M17
-
96
Arauz-Pacheco C, Parrot M A.
The treatment of hypertension in adult patients with diabetes.
Diabetes Care.
2002;
25
134-147
-
10
Avilés-Santa L, Sinding J, Raskin P.
Effects of metformin in patients with poorly controlled, insulin-treated type 2 diabetes mellitus.
Ann Intern Med.
1999;
131
182-188
-
11
Bakris G L, Williams M, Dworkin L, Elliott W J, Epstein M, Toto R, Tuttle K, Douglas J, Hsueh W, Sowers J.
Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group.
Am J Kidney Dis.
2000;
36
646-661
-
12
Brand F N, Kannel W B, Evans J, Larson M G, Wolf P A.
Glucose intolerance, physical signs of peripheral artery disease, and risk of cardiovascular events: the Framingham Study.
Am Heart J.
1998;
136
919-927
-
13
Brandle M, Davidson M B, Schriger D L, Lorber B, Herman W H.
Cost effectiveness of statin therapy for the primary prevention of major coronary events in individuals with type 2 diabetes.
Diabet Care.
2003;
26
1796-1801
-
14
Chalmers J, MacMahon S, Mancia G, Whitworth J, Beilin L.
World Health Organization - International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee.
Clin Exp Hypertens.
1999;
21
1009-1060
-
15
Chobanian A V, Bakris G L, Black H R, Cushman W C, Green L A, Izzo J L, Jones D W, Materson B J, Oparil S, Wright J T, Roccella E J. and the National High Blood Pressure Education Programm Coordinating Committee .
The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 report.
JAMA.
2003;
289
2560-2572
-
16
Corpus R A, George P B, House J A, Dixon S R, Ajulin S C, Devlin W H, Timmis G C, Balasubramaniam M, O'Neill W W.
Optimal glycemic control is associated with lower rate of target vessel revascularisation in treated type II diabetic patients undergoing elective percutaneous coronary intervention.
J Am Coll Cardiol.
2004;
43
8-14
-
17
Curb J D, Pressel S L, Cutler J A. et al .
Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group.
JAMA.
1996;
276
1886-1892
-
18 Deutsche Hochdruckliga. Deutsche Hypertonie Gesellschaft .Empfehlungen zur Hochdruckbehandlung. 16th ed. Heidelberg; Deutsche Hochdruckliga 2001
-
19
Expert Panel on Detection .
Executive Summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III).
JAMA.
2001;
285
2486-2497
-
20
Feingold K R, Grunfeld C, Pang M, Doerrler W, Krauss R M.
LDL subclass phenotypes and triglyceride metabolism in non-insulin dependent diabetes.
Ateroscler Thromb.
1992;
12
1496-1502
-
21
Folsom A R, Chambless L E, Duncan B B, Gilbert A C, Pankow J S.
Prediction of coronary heart disease in middle-aged adults with diabetes.
Diabet Care.
2003;
26
2777-2784
-
22
Fonseca V, Rosenstock J, Patwardhan, Salzman A.
Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus. A randomized, controlled trail.
J Am Med Assoc.
2000;
283
1695-1702
-
23
Fuller J H, Head J.
Blood pressure, proteinuria and their relationship with circulatory mortality: the WHO multinational study of vascular disease in diabetics.
Diabetes Metab.
1998;
15
273-277
-
24
Gaede P, Vedel P, Larsen N, Jensen G VH, Parving H-H, Pedersen O.
Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.
N Engl J Med.
2003;
348
383-393
-
25
Gagne C, Bays H E, Weiss S R, Mata P, Quinto K, Melino M, Cho M, Musliner T A, Gumbiner B.
Efficacy and safety of ezetimibe added to ongoing statin therapy for treatment of patients with primary hypercholesterinemia.
Am J Cardiol.
2002;
90
1084-1091
-
26
Gentile S, Turco S, Guarino G, Sasso C F, Amodio M, Magliano P, Salvatore T, Corigliano G, Agrusta M, De Simone G, Gaeta I, Oliviero B, Torella R.
Comparative efficacy study of atorvastatin vs. simvastatin, pravastatin, lovastatin and placebo in type 2 diabetic patients with hypercholesterinemia.
Diabetes Obesity Metabol.
2000;
2
355-362
-
27
Gohlke H, Kübler W, Mathes P, Meinertz T, Schuler G, Gysan D B, Sauer G.
Recommendations for an extensive risk decrease for patients with coronary disease, vascular diseases and diabetes. Issued by the Executive Committee of the German Society of Cardiology, Heart and Circulation Research, reviewed on behalf of the Clinical Cardiology Commission by the Prevention Project Group.
Z Kardiol.
2001;
90
148-149
-
28
Goldberg R B, Mellies M J, Sacks F M, Moye L A, Howard B V, Howard W J, Davis B R, Cole T G, Pfeffer M A, Braunwald E.
Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the cholesterol and recurrent events (CARE) trial. The Care Investigators.
Circulation.
1998;
98
2513-2519
-
29
Greco A V, Mingrone G, Giancaterini A, Manco M, Morroni M, Cint S, Granzotto M, Vettor R, Camastra S, Ferrannini E.
Insulin resistance in morbid obesity. Reversal with intramyocellular fat depletion.
Diabetes.
2002;
51
144-151
-
30
Guidelines Committee .
2003 European society of hypertension - european society of cardiology guidelines for the management of arterial hypertension.
J Hypertens.
2003;
21
1011-1053
-
31
Haffner S M, Hanley A JG.
Do increased proinsulin concentrations explain the excess risk of coronary heart disease in diabetic and prediabetic subjects?.
Circulation.
2002;
105
2008-2009
-
32
Haffner S M, Lehto S, Ronnemaa T, Pyorala K, Laakso M.
Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. Implications for treatment of hyperlipidemia in diabetic subjects without prior myocardial infarction.
N Engl J Med.
1998;
339
229-234
-
33
Haller H.
Posprandial glucose and vascular disease.
Diabetic Medicine.
1997;
14
S50-S56
-
34
Hanefeld M, Fischer S, Schmechel H, Rothe G, Schulze J, Dude H, Schwanebeck U, Julius U.
Diabetes Intervention Study. Multi-intervention trial in newly diagnosed NIDDM.
Diabet Care.
1991;
14
308-317
-
35
Hanefeld M, Temelkova-Kurktschiev T, Schaper F, Henkel E, Siegert G, Koehler C.
Impaired fasting glucose is not a risk factor for atherosclerosis.
Diabetic Medicine.
1999;
16
212-218
-
36
Hansson L, Zanchetti A, Carruthers S G, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn K H, Wedel H, Westerling S.
Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT). HOT Study Group.
Lancet.
1998;
351
1755-1762
-
37
Häring H-U, Joost H-G, Laube H, Matthaei S, Meissner H-P, Panten U, Schernthaner G.
Evidenzbasierte Diabetes-Leitlinien DDG (Diskussionsentwurf). Antihyperglykämische Therapie des Diabetes mellitus Typ 2.
Diabetes und Stoffwechsel.
2001;
10
223-236
-
38
Hauner H, Köster I, von Ferber L.
Prävalenz des Diabetes mellitus in Deutschland 1998 - 2001.
Dtsch Med Wochenschr.
2003;
128
2632-2638
-
39
Heart Protection Study Collaborative Group .
MRC/BHF Heart protection study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial.
Lancet.
2003;
361
2005-2016
-
40
Heart Protection Study Collaborative Group .
MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial.
Lancet.
2002;
360
7-22
-
41
Heinemann L, Heise T.
Klinische Wirkungen und Pharmakodynamik der Insulinanaloga Lispro, Aspart und Glargin.
Dtsch Med Wschr.
2001;
126
597-604
-
42
Hermann L S, Ranstam J, Vaaler, Melander A.
Effects of antihyperglycaemic therapies on proinsulin and relation between proinsulin and cardiovascular risk factors in type 2 diabetes.
Diabetes Obes Metab.
1999;
1
227-232
-
43
Home P D, Boulton A JM, Jimenez J, Landgraf R, Osterbrink B, Christiansen J S.
Issues relating to the early or earlier use of insulin in type 2 diabetes.
Pract Diab Int.
2003;
20
63-71
-
44
Hypertension in Diabetes Study Group .
Hypertension in Diabetes Study (HDS): II. Increased risk of cardiovascular complications in hypertensive type 2 diabetic patients.
J Hypertens.
1993;
11
319-325
-
45
Janka H U, Standl E, Bloss G, Oberparleiter F, Mehnert H.
On the epidemiology of hypertension in diabetics.
Dtsch Med Wochenschr.
1978;
103
84-87
-
46
Jarrett R J, Shipley M J.
The Whitehall Study: comparative mortality rates and indices of risk in diabetes.
Acta Endocrinol.
1985;
110
21-26
-
47
Jeu L A, Cheng J WM.
Pharmacology and therapeutics of ezetimibe (SCH 58 235), a cholesterol-absorption inhibitor.
Clin Ther.
2003;
25
2352-2387
-
48
Joint National Committee .
The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
Arch Intern Med.
1997;
157
2413-2443
-
49
Kalfhaus J, Berger M.
Insulin treatment with preprandial injections of regular insulin in middle-aged type 2 diabetic patients. A two years observational study.
Diabetes & Metabolism.
2000;
26
197-201
-
50
Kannel W B, McGee D L.
Diabetes and cardiovascular risk factors in the framingham study.
Circulation.
1993;
59
8-13
-
51
Keech A, Colquhoun D, Best J, Kirby A, Simes R J, Hunt D, Hague W, Beller E, Arulchelvam M, Baker J, Tonkin A.
Secondary prevention of cardiovascular events with long-term pravastatin in patients with diabetes or impaired fasting glucose.
Daibetes Care.
2003;
26
2713-2721
-
52
Klocke K R, Stauch K, Landen H.
Effect of add-on acarbose to insulin therapy in routine clinical practice.
Clin Drug Invest.
2003;
23
621-627
-
53
Lefèbvre P J, Scheen A J.
Glucose metabolism and the postprandial state.
Eur J Clin Invest.
1999;
29
1-6
-
54
Lüscher T F, Creager M A, Beckman J A, Cosentino F.
Diabetes and vascular disease. Pathophysiology, clinical consequences, and medical therapy: part II.
Circulation.
2003;
108
1655-1661
-
55
Malmberg K, Norhammar A, Wedel H, Rydén L.
Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction.
Circulation.
1999;
99
2626-2632
-
56
Manninen V, Tenkanen L, Koskinen P, Huttunen J K, Manttari M, Heinonen O P, Frick M H.
Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment.
Circulation.
1992;
85
37-45
-
57
Mathiesen E R, Borch-Johnsen K, Jensen D V, Deckert T.
Improved survival in patients with diabetic nephropathy.
Diabetologia.
1989;
32
884-886
-
58
Menzel R, Kerner W, Meinecke G, Schmohl M.
Typ-2-Diabetes: Insulintherapie kombiniert mit Metformin im Vergleich zur Insulinmonotherapie.
Diabetes und Stoffwechsel.
2002;
11
167-174
-
59
Miettinen H, Lehto S, Salomaa V, Mahonen M, Niemela M, Haffner S M, Pyorala K, Tuomilehto J.
Impact of diabetes on mortality after the first myocardial infarction.
Diabetes Care.
1998;
21
69-75
-
60
Nathan D M.
Long-term complications of diabetes mellitus.
N Engl J Med.
1993;
328
676-685
-
61
Nationales Programm für Versorgungs-Leitlinien bei der Bundesärztekammer .
Nationale Versorgungs-Leitlinie Diabetes mellitus Typ 2. Mai 2002; Kurzfassung.
Diabetes und Stoffwechsel.
2002;
11
185-205
-
62
Oh J-Y, Barret-Connor E, Wedick N M.
Sex differences in the association between proinsulin and intact insulin with coronary heart disease in nondiabetic older adults.
Circulation.
2002;
105
1311-1316
-
63
Parving H H, Hommel E.
Prognosis in diabetic nephropathy.
BMJ.
1989;
229
230-233
-
64
Practice Guidelines Writing Committee .
Practice guidelines for primary care physicians: 2003 ESH/ESC hypertension guidelines.
J Hypertens.
2003;
21
1011-1053
-
65
Pyorala K, Pedersen T R, Kjekshus J, Faergeman O, Olsson A G, Thorgeirsson G.
Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival Study (4 S).
Diabet Care.
1997;
20
614-620
-
66
Reaven P D, Barrett-Connor E L, Browner D K.
Abnormal glucose tolerance and hypertension.
Diabet Care.
1990;
13
119-125
-
67
Rosengren A, Welin L, Tsipogianni A, Wilhelmsen L.
Impact of cardiovascular risk factors on coronary heart disease and mortality among middle aged diabetic men: a general population study.
BMJ.
1989;
299
1127-1131
-
68
Rubins H B, Robins S J, Collins D, Nelson D B, Elam M B, Schaefer E J, Faas F H, Anderson J W.
Diabetes, plasma insulin, and cardiovascular disease.
Arch Intern Med.
2002;
162
2597-2604
-
69
Sacks F M, Pfeffer M A, Moye L A, Rouleau J L, Rutherford J D, Cole T G, Brown L, Warnica J W, Arnold J M, Wun C C, Davis B R, Braunwald E.
The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels.
N Eng J Med.
1996;
335
1001-1009
-
70
Sawicki P T, Mühlhauser I, Didjurgeit U.
Mortality and morbidity in treated hypertensive type 2 diabetic patients with micro- or macro-proteinuria.
Diabet Med.
1995;
12
893-898
-
71
Scandinavian Simvastatin Survival Study Group .
Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4 S).
Lancet.
1994;
344
1383-1389
-
72
Schäfers R F, Lütkes P, Ritz E, Philipp T.
Leitlinie zur Behandlung der arteriellen Hypertonie bei Diabetes mellitus.
DMW.
1999;
124
1356-1372
-
97 Second joint task force of European and other societies on coronary heart disease in clinical practice .Recommendation of the second joint task force of European and other societies on coronary prevention Euro Heart.
-
73
Shaw J E, Hodge A M, de Courten M, Chitson P, Zimmet P Z.
Isolated post-challenge hyperglycemia confirmed as a risk factor for mortality.
Diabetologia.
1999;
42
1050-1054
-
74
Shek A, Ferill M J.
Statin-fibrate combination therapy.
Ann Pharmacother.
2001;
35
908-917
-
75
Siegel E G, Jakobs R, Riemann J F.
Pankreopriver und hepatogener Diabetes.
Internist.
2001;
42
S8-S19
-
76
Simonson D C.
Etiology and prevalence of hypertension in diabetic patients.
Diabet Care.
1988;
11
821-827
-
77
Snow V, Weiss K B, Mottur-Pilson C.
The evidence base for tight blood pressure control in the management of type 2 diabetes mellitus.
Ann Intern Med.
2003;
138
587-592
-
78
Stamler J, Vaccaro O, Neaton J D, Wentworth D.
Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the multiple risk factor intervention trial.
Diabet Care.
1993;
16
434-444
-
79
Standl E, Balletshofer B, Dahl B, Weichenhain B, Stiegler H, Hormann A, Holle R.
Predictors of 10-year macrovascular and overall mortality in patients with NIDDM: the Munich General Practitioner Project.
Diabetologia.
1996;
39
1540-1545
-
80
Standl E, Fuchs C, Parandeh-Shab F, Janka U H, Landgraf R, Lengeling H-F, Phillip T, Petzoldt R, Sawicki P, Scherbaum W A, Tschöpe D.
Hypertonie beim Diabetes Mellitus. In: Scherbaum WA, Landgraf R (eds). Praxisleitlinien der Deutschen Diabetes-Gesellschaft (DDG).
Diabetes und Stoffwechsel.
2002;
11
20-22
-
81 Standl E, Fuchs C, Parandeh-Shab F, Janka U H, Landgraf R, Lengeling H-F, Phillip T, Petzoldt R, Sawicki P, Scherbaum W A, Tschöpe D. Management der Hypertonie beim Patienten mit Diabetes mellitus. Scherbaum WA, Lauterbach KW, Renner R Evidenzbasierte Diabetes-Leitlinien DDG. 1st ed. Deutsche Diabetes-Gesellschaft 2000
-
82
Standl E, Stiegler H, Roth R, Schulz K, Lehmacher W.
On the impact of hypertension on the prognosis of NIDDM. Results of the Schwabing GP-Program.
Diabetes Metab.
1989;
15
352-358
-
83
Stratton I M, Adler A I, Neil H AW, Matthews D R, Manley S E, Cull C A, Hadden D, Turner R C, Holman R R.
On behalf of the UK Prospective Diabetes Study Group: Association of glycaemia with macrovascular and microvascular complications of type-2-diabetes (UKPDS 35): prospective observational study.
BMJ.
2000;
321
405-412
-
84
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group .
Major Outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic.
JAMA.
2002;
288
2981-2997
-
85
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus .
Follow-up report on the diagnosis of diabetes mellitus.
Diabet Care.
2003;
11
3160-3167
-
86
Tomigana M, Igarashi K, Eguchi H, Kato T, Manaka H, Sekikawa A.
Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose.
Diabet Care.
1999;
22
920-924
-
87
Tuomilehto J, Rastenyte D, Birkenhager W H, Thijs L, Antikainen R, Bulpitt C J, Fletcher A E, Forette F, Goldhaber A, Palatini P, Sarti C, Fagard R.
Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic hypertension in Europe trail investigators.
N Engl J Med.
1999;
340
677-684
-
88
Turner R C.
The U. K. prospective diabetes study. A review.
Diabet Care.
1998;
21
C35-38
-
89
UKPDS Group .
Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.
BMJ.
1998;
317
703-713
-
90
Van den Berghe G, Wouters D, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R.
Intensive insulin therapy in critically ill patients.
N Engl J Med.
2001;
345
1359-1367
-
91
West K M, Ahuja M M, Bennett P H, Czyzyk A, De Acosta O M, Fuller J H, Grab B, Grabauskas V, Jarrett R J, Kosaka K.
The role of circulating glucose and triglyceride concentrations and their interactions with other “risk factors” as determinants of arterial disease in nine diabetic population samples from the WHO multinational study.
Diabet Care.
1983;
6
361-369
-
92
Wild S, Roglic G, Green A, Sicree R, King H.
Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
Diabet Care.
2004;
27
1047-1054
-
93
Yudkin J S, May M, Elwood P, Yarnell J W, Greenwood R, Davey Smith G.
Concentrations of proinsulin like molecules predict coronary heart disease risk independently of insulin: prospective data from the Caerphilly study.
Diabetologia.
2002;
45
327-336
-
94
Zethelius B, Byberg L, Hales C N, Lithell H, Berne C.
Proinsulin is an independent predictor of coronary heart disease.
Circulation.
2002;
105
2153-2158
-
95
Zimmet P Z, McCarty D J, De Courten M P.
The global epidemiology of non-insulin-dependent diabetes mellitus and the metabolic syndrome.
J Diabetes Complications.
1997;
11
60-68
M. D. Andreas Clemens
Hübschstraße 16
76135 Karlsruhe
Germany
Telefon: + 49(0)7218304691
eMail: a_clemens@gmx.de
