Chronic stable angina treatment diabetes control

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

Overview
Diabetes is one of the major modifiable risk factors for coronary artery disease. Maintaining a good glycemic control has been demonstrated to delay the disease progression in patients with impaired glycemic control and further prevent microvascular complications. In type 1 diabetics, appropriate insulin therapy and concomitant dietary modification may be required. However, in patients with type 2 diabetes, a multi-factorial intervention involving increased physical activity, weight reduction, dietary modification and/or drug therapy has shown to reduce the risk of overall cardiovascular and microvascular events by approximately 50%.

Supportive trial data

 * The PROactive study, a prospective, randomized control trial of 5,238 patients with type 2 diabetes and evidence of macrovascular disease, assed the efficacy of pioglitazone on macrovascular morbidity and mortality in high-risk patients with type 2 diabetes. Researchers reported a significant reduction in the incidence of composite primary endpoint that included death or non-fatal MI. Findings also suggested that the addition of pioglitazone to other hypoglycemic agents provided better overall clinical outcomes.


 * The Steno-2 study, a randomized parallel trial of 160 patients who either received conventional treatment based on national guidelines or intensive treatment involving behavior modification and pharmacologic therapy, assessed the effect of multi-factorial intervention in patients with type 2 diabetes and microalbuminuria. Researchers demonstrated a significant reduction in the risk of cardiovascular disease (hazard ratio: 0.47; 95% CI, 0.24, 0.73) and nephropathy (hazard ratio: 0.39; 95% CI, 0.17, 0.87). It was reported that when a target-driven, long-term, multi-factorial intervention was applied to patients with type 2 diabetes and microalbuminuria the risk of cardiovascular disease could be reduced by approximately 50%.

==ACC/AHA Guidelines- Cardiovascular Risk Factor Reduction- Diabetes Management (DO NOT EDIT)  == {{cquote|

Class I
1. Diabetes management should include lifestyle and pharmacotherapy measures to achieve a near-normal HbA1c. (Level of Evidence: B)

2. Vigorous modification of other risk factors (e.g., physical activity, weight management, blood pressure control, and cholesterol management) as recommended should be initiated and maintained. (Level of Evidence: B)

Class IIb
1. Expanding physical activity to include resistance training on 2 days per week may be reasonable. (Level of Evidence: C)}}

Vote on and Suggest Revisions to the Current Guidelines

 * The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines