Updated guidelines address CVD prevention in adults with type 2 diabetes

The American Diabetes Association and the American Heart Association recently released a revised joint scientific statement outlining best practices to reduce cardiovascular risk in adults with type 2 diabetes, published in both Diabetes Care and Circulation.

The scientific statement, first published in 1999 and last revised in 2007, includes information from several new clinical trials since 2008 that have changed the clinical practice of CVD risk management in adults with type 2 diabetes, according to researchers.

Caroline Fox

Caroline S. Fox

Caroline S. Fox, MD, of the National Heart, Lung, and Blood Institute, and Sherita Hill Golden, MD, executive vice chair of the department of medicine and professor of medicine at Johns Hopkins University, co-chaired the committee producing the revised statement.

“Given the changes in the diabetes mellitus landscape over the past 5 years, the purpose of this scientific statement is to summarize key clinical trials pertaining to lifestyle, blood glucose, blood pressure and cholesterol management for the primary prevention of CVD,” the researchers wrote. “We have synthesized the established clinical guidelines and clinical targets for the contemporary management of patients with type 2 diabetes to reduce CVD risk.”

The updated statement includes the ADA HbA1c diagnostic criteria for both prediabetes and type 2 diabetes, officially recommended for the first time in 2010, and updated guidelines for lifestyle management, including physical activity, nutrition and supplement use. The statement also includes recommendations on weight management and surgical options for weight loss, aspirin use, glucose control and BP and lipid management to reduce CVD risk.

The researchers also highlighted six “areas of controversy” that they said require further research to advance CDV prevention in adults with type 2 diabetes, including the role of antihyperglycemic therapy and bariatric surgery, the burden of hypoglycemia and its risks, whether lower BP and cholesterol targets are appropriate, and whether screening for subclinical coronary artery disease in adults with type 2 diabetes can reduce CVD event rates.

The researchers noted that mortality rates from CAD have declined and CVD outcomes have improved in recent years, but CVD risks associated with type 2 diabetes persist.

“As a result, considerable work needs to be done to enhance our understanding of how to more effectively prevent CVD in patients with type 2 diabetes,” the researchers wrote. by Regina Schaffer

Disclosure: Fox and Golden report no relevant financial disclosures. Please see the full statement for a list of all other authors’ relevant financial disclosures.

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