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Diabetes: Difference between revisions
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!colspan="3"|Treatment to reduce cardiovascular risk <cite>34</cite> | !colspan="3"|Treatment to reduce cardiovascular risk <cite>34</cite> | ||
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|colspan="3"|'''Lifestyle and comprehensive management''' | |bgcolor="#CCCCFF" colspan="3"|'''Lifestyle and comprehensive management''' | ||
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!Recommendation | !Recommendation | ||
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===Treatments and outcomes=== | ===Treatments and outcomes=== | ||
{| class="wikitable" border="0" cellpadding="0" cellspacing="0" width="600px" | |||
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!colspan="3"|Peripheral vascular disease<cite>34</cite> | |||
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|bgcolor="#CCCCFF" colspan="3"| | |||
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!Recommendation | |||
!Class<sup>a</sup> | |||
!Level<sup>b</sup> | |||
|- | |||
|All patients with type 2 diabetes and CVD are recommended treatment with low-dose aspirin | |||
!IIa | |||
!B | |||
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|In diabetic patients with peripheral vascular disease, treatment with clopidogrel or low molecular weight heparin may be considered in certain cases | |||
!IIa | |||
!B | |||
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|Patients with critical limb ischaemia should, if possible, undergo revascularization procedures | |||
!I | |||
!B | |||
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|An alternative treatment for patients with critical limb ischaemia, not suited for revascularization, is prostacyclin infusion | |||
!I | |||
!A | |||
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|bgcolor="#CCCCFF" colspan="3"| | |||
'''<sup>a</sup>Class of recommendation.''' | |||
'''<sup>b</sup>Level of evidence.''' | |||
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Peripheral vascular diseases: Preventions are most important strategies, such as regular exercises, the optimization of glycemic control, management of hypertension, smoking cessation, antiplatelet and anti-cholesterol medications like aspirin, clopidogrel and statins. | Peripheral vascular diseases: Preventions are most important strategies, such as regular exercises, the optimization of glycemic control, management of hypertension, smoking cessation, antiplatelet and anti-cholesterol medications like aspirin, clopidogrel and statins. | ||
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If anatomically possible, a revascularization procedure should be attempted in all patients with critical limb ischemia,<cite>65</cite> such as an angioplasty or a bypass grafting can be done on solitary lesions in large arteries like the femoral artery, but the revascularization may not have sustained benefits. A synthetic prostacyclin (Ilomedin, Iloprost) is the only pharmacological agent so far convincingly shown to have significant beneficial effects on ulcer healing and pain relief on patients with critical limb ischemia, which is given intravenously daily for a period of 2–4 weeks.<cite>66</cite> | If anatomically possible, a revascularization procedure should be attempted in all patients with critical limb ischemia,<cite>65</cite> such as an angioplasty or a bypass grafting can be done on solitary lesions in large arteries like the femoral artery, but the revascularization may not have sustained benefits. A synthetic prostacyclin (Ilomedin, Iloprost) is the only pharmacological agent so far convincingly shown to have significant beneficial effects on ulcer healing and pain relief on patients with critical limb ischemia, which is given intravenously daily for a period of 2–4 weeks.<cite>66</cite> | ||
{| class="wikitable" border="0" cellpadding="0" cellspacing="0" width="600px" | |||
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!colspan="3"|Stroke<cite>34</cite> | |||
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|bgcolor="#CCCCFF" colspan="3"| | |||
|- | |||
!Recommendation | |||
!Class<sup>a</sup> | |||
!Level<sup>b</sup> | |||
|- | |||
|For stroke prevention, blood pressure lowering is more important than the choice of drug. Inhibition of the renin–angiotensin–aldosterone system may have additional benefits beyond blood pressure lowering ''per se'' | |||
|IIa | |||
|B | |||
|- | |||
|Patients with acute stroke and diabetes should be treated according to the same principles as stroke patients without diabetes | |||
|IIa | |||
|C | |||
|- | |||
|bgcolor="#CCCCFF" colspan="3"| | |||
'''<sup>a</sup>Class of recommendation.''' | |||
'''<sup>b</sup>Level of evidence.''' | |||
|} | |||
Cerebrovascular diseases: Stroke prevention should be based on a multifactorial strategy aimed at the treatment of hypertension, hyperlipidemia, microalbuminuria, hyperglycemia and the use of antiplatelet medications. Antiplatelet therapy reduces the incidence of stroke in diabetic patients and is indicated for both primary and secondary prevention.<cite>67</cite> Low dose Aspirin (75–250 mg daily) should be the initial choice, but in case of intolerance, clopidogrel 75 mg once daily should be given.<cite>68</cite> In patients with recurrent stroke, a combination of aspirin and dipyridamol should be a better option. | Cerebrovascular diseases: Stroke prevention should be based on a multifactorial strategy aimed at the treatment of hypertension, hyperlipidemia, microalbuminuria, hyperglycemia and the use of antiplatelet medications. Antiplatelet therapy reduces the incidence of stroke in diabetic patients and is indicated for both primary and secondary prevention.<cite>67</cite> Low dose Aspirin (75–250 mg daily) should be the initial choice, but in case of intolerance, clopidogrel 75 mg once daily should be given.<cite>68</cite> In patients with recurrent stroke, a combination of aspirin and dipyridamol should be a better option. | ||