New European Society of Cardiology Guidelines on diabetes; prediabetes and cardiovascular diseases - a truly strong base for the major paradigm shift in clinical practice?

摘要

The prevalence of diabetes mellitus (DM) continues to increase globally, and in many countries that were considered less developed until recently, its rate rose up to 10% in the gene-ral population. On the other hand, it has been also found that almost up to 50% of DM cases remain undiagnosed. Such a trend led to the alarming projections that before 2045, more than 600 million individuals would present with DM worldwide, and about the same number will develop pre-diabetes. This fact can lead to an enormous rise in the prevalence of premature cardiovascular disease (CVD) and its consequences, but at the same time, it presents an enormous public health and societal burden, also due to the effects of advancing age and comorbidities. Chronic complications in DM include macrovascular [myocardial infarction (MI), stroke, need for revascularization, and peripheral vascular disease], as well as microvascular disease (retinopathy, nephropathy, and neuropathy). It was demonstrated that indivi-duals with one (regardless of type) microvascular complication had the CVD risk increased for 35%–40%. Increasing number of microvascular complications resulted in a stepwise increase in the composite of CV deaths, nonfatal MI, nonfatal stroke, and also in hospitalization for heart failure (HF), CV mortality, and all-cause mortality.