[Type 2 diabetes mellitus and coronary heart disease]

Abstract

Coronary artery disease is the most common cause of morbidity and mortality in subjects with type 2 diabetes mellitus. The risk of coronary artery disease, myocardial infarction and mortality from myocardial infarction is markedly increased in type 2 diabetic patients compared with non-diabetics. Diabetic patients with acute myocardial infarction should receive thrombolytic therapy as rapidly as possible and for the same indications as non-diabetics. Diabetic retinopathy is not a contraindication to treatment. The management of diabetic patients should also include medication with aspirin, beta-blockers and ACE-inhibitors. An insulin-glucose infusion during acute myocardial infarction, followed by insulin injections subcutaneously, reduces mortality by about 30% after 12 months and improves long-term prognosis. Thus, insulin-glucose infusion in diabetic patients with acute myocardial infarction, especially in those with a high blood glucose level (> 11 mmol/l), seems advisable. Diabetic patients benefit from secondary prevention by drug therapy (aspirin, lipid lowering with statins, beta-blockers and ACE-inhibitors) to the same extent as, or more than, non-diabetic patients.