Pharmacological treatment of diabetic patients with respect to prevention of macrovascular disease

Abstract

Prevention of atherosclerosis in type 2 diabetes ideally should start a long time before the diagnosis of diabetes since type 2 diabetes and atherosclerosis have a common background of metabolic syndrome. Identifying subjects with metabolic syndrome and beginning with lifestyle and drug interventions in such subjects would most probably delay the development of both diabetes and atherosclerosis. After the clinical diagnosis of diabetes, it is necessary to continue with multifactorial interventions targeted on risk factors, such as hyperglycaemia, dyslipidaemia and hypertension. Some interventions appear to have a benefit beyond the effect on risk factors. Effects of these interventions can be explained by their influence on some pathogenic mechanisms, such as insulin resistance and endothelial dysfunction. Multifactorial interventions decrease the incidence of macrovascular disease in diabetes at least by one-half and should be routinely used in the majority of patients with type 2 diabetes.