Managing cardiometabolic risk in type 2 diabetes care

Nurten Terkes; Hicran Bektas

doi:10.1530/endoabs.43.OC11

Background: Cardiometabolic risk (CMR) refers to risk factors that increase the likelihood of experiencing vascular events or developing diabetes. This concept encompasses traditional risk factors, such as hypertension, dyslipidemia, smoking. Abnormal glucose metabolism is a risk factor for cardiovascular disease (CVD) and, in some individuals, may progress to meet the threshold for the diagnosis of diabetes. CVD is the leading cause of death in the worldwide, and nearly one quarter of deaths caused by CVD are considered to be preventable.

Aim: The aim of this review is to provide evidence-based recommendations for preventing the development of cardiovascular disease in patients with type 2 diabetes.

Methods: Akdeniz University electronic databases center including MEDLINE, CINAHL and PUBMED e.g. were searched studies published in English within the last five years with key words such as ‘cardiovascular disease in patients with type 2 diabetes’, ‘evidence-based recommendations and cardiovascular disease’ and ‘evidence-based recommendations in patients with type 2 diabetes’. Randomized control studys, systematic reviews, international guideline and meta-analyses were reviewed for evidence-based recommendations for preventing the development of cardiovascular disease in patients with type 2 diabetes.

Results: The primary treatment of elevated CMR is lifestyle modification. Evidence-based recommendations for preventing the development of cardiovascular disease in patients with type 2 diabetes are given in Table 1.

**Table 1** Evidence-based recommendations for preventing the development of cardiovascular disease in patients with type 2 diabetes
1. In all patients with diabetes, cardiovascular risk factors should be systematically assessed at least annually,
2. Blood pressure should be measured at every routine visit (Evidence-based (B)).
3. People with diabetes and hypertension should be treated to a systolic blood pressure goal of < 140 mmHg and a diastolic blood pressure goal of <90 mmHg (Evidence-based (A)).
4. Patients with blood pressure >120/80 mmHg should be advised on lifestyle changes to reduce blood pressure (Evidence-based (A)).
• Weight loss, if over weight or obese,
• Improve diet quality, including salt restriction (<2.000 mg/day),
• Increasing potassium intake,
• Regular exercise (3–5 d/wk; 30–60 min/d)
• Caloric restriction,
• Reduction of saturated fat, trans fat. and cholesterol intake,
• Increase of omega-3 fatty acids, viscous fiber, and plant stanols/sterols intake.
• Smoking cessation counseling.
5. For patients with diabetes at risk for cardiovascular disease, diets high in fruits, vegetables, whole grains, and nuts may reduce the risk (Evidence-based (C)).
6. Patients with confirmed office-based blood pressure >140/90 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely subsequent titration of pharmacological therapy to achieve blood pressure goals (Evidence-based (A)).
7. Pharmacological therapy for patients with diabetes and hypertension should comprise a regimen that includes either an ACE inhibitor or an angiotensin receptor blocker but not both. B If one class is not tolerated, the other should be substituted (Evidence-based (C)).
8. If ACE inhibitors, angiotensin receptor blockers, or diuretics are used, serum crcatinine/estimated glomerular filtration rate and serum potassium levels should be monitored (Evidence-based (E)).
9. Consider aspirin therapy (75–162 mg/day) as a primary prevention strategy in those with type 2 diabetes who are at increased cardiovascular risk (Evidence-based (C)).
10. Prescribe aspirin therapy (75–325 mg/day) for all adult patients with type 2 diabetes and evidence of cardiovascular disease (Evidence-based (A)).
11. Use aspirin therapy (75–162 mg/day) as a secondary prevention strategy in those with diabetes with history of CVD (Evidence-based (A)).
12. Statins are first line agents in primary and secondary prevention of CVD regardless of HDL-C or TG level.
13. Statin Therapy (Aged 40–80 years) is recommended for all patients aged 40–80 years with diabetes and total cholesterol (TC)>135, regardless of baseline LDL (Evidence-based (A)),
14. For patients of all ages with diabetes and atherosclerotic cardiovascular disease, high-intensity statin therapy should be added to lifestyle therapy (Evidence-based (A)).
^*Evidence-based recommendations are classified according to “Standards of Medical Care in Diabetes”

Conclusion: Accordingly, regular screening for CMR allows health professionals to identify high-risk individuals who might not otherwise be defined as high risk when examined using traditional approaches only. Early assessment of a patient’s CMR profile facilitates individualized therapeutic strategies that might prevent long-term complications. Education is one of the most important interventions needed to prevention cardiometabolic risk in diabetes patients. Nurse practitioners are central to care, and to the provision of education, with key roles in the assessment of physical health, and the implementation and coordination of treatment plans.

Endocrine Abstracts

OC11