Diabetes mellitus type 2 secondary prevention

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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]


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

Abbreviations: CVD: Cardiovascular disease

Age Risk factors Recommended statin dose
<40 years None

CVDrisk factor(s)

Overt CVDΔ


Moderate or high


40 to 75 years None

CVD risk factors

Overt CVD




>75 years None

CVD risk factors

Overt CVD


Moderate or 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.

  • 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
  • Weight reduction [9]
  • Regular dental care


  1. 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.
  2. 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.
  3. 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.
  4. 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)
  5. "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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.