Effective Management of the Type 2 Diabetes Patient with Cardiovascular and Renal Disease: Secondary Prevention Strategies after a Myocardial Infarction

摘要

The prevalence of type 2 diabetes mellitus has reached epidemic proportions and continues to grow in nations throughout the world. This disease is typically accompanied by other related conditions that each pose a hazard to the health of these patients and exacerbate the risk associated with diabetes for cardiovascular morbidity and mortality. Despite guideline recommendations for assessment and treatment of all of these related conditions, many patients do not achieve treatment goals. In this article, an archetypal case study is presented based on patient characteristics and conditions typically encountered in the clinic. After sustaining a myocardial infarction, the patient undergoes comprehensive evaluation and is noted to have multiple poorly controlled risk factors for cardiovascular disease and nephropathy. A multidisciplinary approach is advocated, not only to address blood glucose levels, but also to treat risk factors and comorbid conditions commonly associated with type 2 diabetes mellitus (adverse lifestyle behaviors, obesity, hypertension, albuminuria, and dyslipidemia) and complications resulting from this disease (secondary cardiovascular events, as well as nephropathy, retinopathy, and neuropathy). This comprehensive approach helps to maximize both the likelihood of reaching treatment targets for blood glucose, blood pressure, and serum lipids, and reducing the long-term risk of diabetes-related morbidity and mortality.