Volume 109, Issue s51

The United States is experiencing a marked increase in rates of diabetes mellitus and metabolic syndrome, almost certainly in part due to the increase in obesity rates. This phenomenon is likely to also result in an increased risk of coronary artery disease as risk factors increase exponentially. This article defines diabetic dyslipidemia, the rationale for aggressive treatment, and options for ongoing management, including nonpharmacologic therapy and medications, alone or in combination, for management of all aspects of the lipid profile.

The control of glycosylated hemoglobin (HbA 1c ) levels is crucial to the successful treatment of patients with diabetes mellitus (T2DM). Glycemic control is a cornerstone for reducing end-organ disease, and HbA 1c is the benchmark for defining glucose control over long durations. The author reviews available information from published clinical trials regarding the benefits of tight glycemic control in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). He notes that published data support the use of tight glucose control for reducing risks of retinopathy, nephropathy, and neuropathy in both patients with T1DM and patients with T2DM. He also notes that early aggressive insulin management of younger individuals with T1DM led to reductions in the incidence of myocardial infarction (MI), stroke, and death. However, published data do not clearly support benefits of tight glucose control for the prevention of cardiovascular events in older patients with long-standing T2DM. The author also reviews recommended treatments for achieving and maintaining glycemic control in patients. He concludes that the most successful treatment requires that physicians encourage patients to actively participate in the management of their own disease, and that physicians provide patients with opportunities to learn the cornerstones of effective therapy.

Cardiovascular disease (eg, myocardial infarction, ischemic stroke) is the leading cause of death in patients who have metabolic syndrome and diabetes mellitus. By effectively treating the whole patient, however, the risk of death from cardiovascular disease can be reduced or prevented. The author describes clinical approaches for achieving this goal. He reviews information that is useful to know about patients regarding modifiable and potentially modifiable risk factors for cardiovascular disease, including hypertension, hyperlipidemia, smoking, activity levels, dietary habits, obesity, carotid artery stenosis, and atrial fibrillation. He also notes the importance of evaluating patients for relevant psychosocial factors such as depression. Finally, the author analyzes treatment options for patients, including effective medications, dietary modification, and exercise—emphasizing the use of pedometers—as well as participation by patients in weight-control support groups.