American Heart Association and American Diabetes Association has recently published an update to the guidelines for the prevention of cardiovascular disease in adults with type 2 diabetes mellitus. There are certain interesting aspects to it.
1. Use of Hemoglobin A1C for the diagnosis of diabetes mellitus
Pre-diabetes = A1C between 5.7% and 6.4%
Diabetes Mellitus = A1C >/= 6.5%
2. Lifestyle Management of Diabetes
Physical Activity
Nutrition
Weight Reduction (through physical activity, nutrition, weight-loss drugs, and/or bariatric surgery)
3. Cardiovascular risk reduction
Control of blood glucose (A1C <7%)
Control of blood pressure (< 140/90)
Control of Cholesterol (statins)
Aspirin for moderate 10-year CVD risk (5-10%)
4. Screening for cardiovascular diseases in asymptomatic patients
Paucity of data suggesting any specific benefits of invasive interventions over medical therapy alone makes any CAD screening in the asymptomatic patient with diabetes mellitus highly controversial.
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