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New Treatment Guidelines for Cardiovascular Disease and Diabetes
The European Society of Cardiology (ESC), in conjunction with the European Association for the Study of Diabetes (EASD), has released new treatment guidelines on diabetes, prediabetes, and cardiovascular diseases.
The guidelines focus on the management of the combination of cardiovascular disease (CVD) (or risk of CVD) and diabetes mellitus (DM). The document describes diagnostic criteria, with an emphasis on fasting plasma glucose > 7.0 mmol/L (126 mg/dL) or 2-hour post-glucose loading values > 11.2 mmol/L (200 mg/dL). Hemoglobin A1c (HbA1c) (> 6.5%) can be used, but there remains concern about its sensitivity. It is therefore recommended that the diagnosis of diabetes be based on HbA1c and fasting plasma glucose (FPG) combined, or on an oral glucose tolerance test (OGTT) if still in doubt.
Other key recommendations include:
- Total fat intake should be < 35%, saturated fat < 10%, and monounsaturated fatty acids > 10% of the total energy.
- A strict low-carbohydrate diet is not recommended.
- Glucose control should be individualized, taking into account the duration of DM, co-morbidities, and age. A target of HbA1c near normal (< 7%) is recommended to decrease micro- and macrovascular complications.
- For type 1 DM, a regimen of basal bolus insulin with frequent glucose monitoring is recommended, whereas metformin should be first-line therapy for type 2 DM.
- Good blood pressure control is important in patients with DM, with target levels of < 140/85 mm Hg.
- An angiotensin-converting enzyme (ACE) inhibitor — or, if not tolerated, an angiotensin receptor blocker (ARB) — is recommended for the treatment of hypertension in DM, particularly in the presence of proteinuria or microalbuminuria.
- Dyslipidemia is a major risk factor for patients with DM and should be treated aggressively, with a low-density lipoprotein cholesterol (LDL-C) target of < 1.8 mmol/L (< 70 mg/dL) or at least a ≥ 50% LDL-C reduction in patients at very high risk.
- Primary prevention with aspirin is not recommended in patients with DM and low cardiovascular risk, but may be considered in those with very high risk on an individual basis.
Source: ESC; September 3, 2013.