Diabetes mellitus type 2 secondary prevention: Difference between revisions
m (Bot: Removing from Primary care) |
No edit summary |
||
Line 4: | Line 4: | ||
==Overview== | ==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]] and the treatment of [[hypertension]] are the most important ones. | The most important aspect of [[Prevention (medical)|secondary prevention]] in [[diabetes mellitus type 2]] is to decrease the [[Mortality rate|mortality]] from [[Macrovascular disease|macrovascular]] [[Complication (medicine)|complications]]. Among the preventive measures, [[lipid]] control, [[smoking cessation]] and the [[treatment]] of [[hypertension]] are the most important ones. | ||
== Secondary Prevention == | == 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.<ref name="pmid12556541">{{cite journal |vauthors=Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O |title=Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes |journal=N. Engl. J. Med. |volume=348 |issue=5 |pages=383–93 |year=2003 |pmid=12556541 |doi=10.1056/NEJMoa021778 |url=}}</ref> Effective measures in this case include:<ref name="pmid14734596">{{cite journal |vauthors=Saydah SH, Fradkin J, Cowie CC |title=Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes |journal=JAMA |volume=291 |issue=3 |pages=335–42 |year=2004 |pmid=14734596 |doi=10.1001/jama.291.3.335 |url=}}</ref> | *[[Prevention (medical)|Secondary prevention]] is focused on decreasing the [[Macrovascular disease|macrovascular]] [[Complication (medicine)|complications]]. | ||
*[[Glycemic control]] | *Application of effective strategies can result in up to 50% risk reduction in [[Macrovascular disease|macrovascular]] [[Complication (medicine)|complications]].<ref name="pmid12556541">{{cite journal |vauthors=Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O |title=Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes |journal=N. Engl. J. Med. |volume=348 |issue=5 |pages=383–93 |year=2003 |pmid=12556541 |doi=10.1056/NEJMoa021778 |url=}}</ref> | ||
*Treatment of lipid | *Effective measures in this case include:<ref name="pmid14734596">{{cite journal |vauthors=Saydah SH, Fradkin J, Cowie CC |title=Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes |journal=JAMA |volume=291 |issue=3 |pages=335–42 |year=2004 |pmid=14734596 |doi=10.1001/jama.291.3.335 |url=}}</ref> | ||
**[[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 [[Diabetes mellitus|diabetic]] patients. The following table summarizes the [[statin]] [[therapy]] strategies: | |||
<span style="font-size:85%">'''Abbreviations:''' | <span style="font-size:85%">'''Abbreviations:''' | ||
'''CVD:''' Cardiovascular disease | '''[[Cardiovascular disease|CVD]]:''' [[Cardiovascular disease]] | ||
</span> | </span> | ||
<br> | <br> | ||
Line 23: | Line 26: | ||
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<40 years | |style="padding: 5px 5px; background: #F5F5F5;" align="left" |<40 years | ||
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |None | |style="padding: 5px 5px; background: #F5F5F5;" align="left" |None | ||
CVD risk factor(s)<sup>¶</sup> | [[Cardiovascular disease|CVD]][[risk factor]](s)<sup>¶</sup> | ||
Overt CVD<sup>Δ</sup> | Overt [[Cardiovascular disease|CVD]]<sup>Δ</sup> | ||
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |None | |style="padding: 5px 5px; background: #F5F5F5;" align="left" |None | ||
Moderate or high | Moderate or high | ||
Line 33: | Line 36: | ||
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |40 to 75 years | |style="padding: 5px 5px; background: #F5F5F5;" align="left" |40 to 75 years | ||
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |None | |style="padding: 5px 5px; background: #F5F5F5;" align="left" |None | ||
CVD risk factors | [[Cardiovascular disease|CVD]] [[risk factor|risk factors]] | ||
Overt CVD | Overt [[Cardiovascular disease|CVD]] | ||
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Moderate | |style="padding: 5px 5px; background: #F5F5F5;" align="left" |Moderate | ||
High | High | ||
Line 43: | Line 46: | ||
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |>75 years | |style="padding: 5px 5px; background: #F5F5F5;" align="left" |>75 years | ||
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |None | |style="padding: 5px 5px; background: #F5F5F5;" align="left" |None | ||
CVD risk factors | [[Cardiovascular disease|CVD]] [[risk factor|risk factors]] | ||
Overt CVD | Overt [[Cardiovascular disease|CVD]] | ||
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Moderate | |style="padding: 5px 5px; background: #F5F5F5;" align="left" |Moderate | ||
Moderate or high | Moderate or high | ||
Line 52: | Line 55: | ||
|} | |} | ||
<small><small> | <small><small> | ||
<sup>† :</sup>In addition to lifestyle therapy. | <sup>† :</sup>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. | ¶ :[[Cardiovascular disease|CVD]] [[risk factor|risk factors]] include [[Low density lipoprotein|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. | Δ :Overt [[Cardiovascular disease|CVD]] includes those with previous [[cardiovascular disease|cardiovascular events]] or [[acute coronary syndromes]]. | ||
</small></small> | </small></small> | ||
*Blood pressure control | *Blood pressure control |
Revision as of 16:47, 13 August 2020
Diabetes mellitus type 2 Microchapters |
Differentiating Diabetes Mellitus Type 2 from other Diseases |
Diagnosis |
Treatment |
Medical therapy |
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 and the treatment of hypertension 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
- Blood pressure should be measured on every visits. Goal of blood pressure 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.[3][4][5] However, subsequent studies have shown this result was more likely due to the administration of ramipril at night and recording blood pressures during the day when the least effect of ramipril was present.[6][7]
- 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
- Smoking cessation
- Using Aspirin
- Weight reduction
- 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.