Cardiovascular considerations in patients with type 2 diabetes

INTRODUCTION

The goals of treatment for type 2 diabetes are to prevent or delay complications and maintain quality of life.¹ According to some international guidelines, this requires control not only of blood glucose levels, but also cardiovascular risk factor management.^1,2

Diabetes is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and most people with type 2 diabetes will have additional cardiovascular risk factors such as smoking, obesity, hypertension, dyslipidaemia and physical inactivity.¹ A multifactorial and simultaneous risk factor management strategy has lead to reductions in both ASCVD events and deaths in patients with diabetes.¹ Guidelines from the European Sociey of Cardiology recommend that this multifactorial approach to diabetes management (encompassing blood pressure, lipid profile, platelet inhibition, smoking cessation, physical activity, weight and dietary habits) should be considered in patients with diabetes and cardiovascular disease (CVD).³

Taking this into account, the choice of drug after metformin is becoming increasingly complex: the prescriber needs to consider cardiovascular risk, renal function and other factors such as hypoglycaemia risk, weight, patient comorbidities including frailty, and patient adherence to treatment.¹

This module looks at the increased risk of cardiovascular disease (CVD) associated with type 2 diabetes, the role of pharmacotherapy in managing the condition in line with current guidelines, and provides an overview of the Cardiovascular Outcome Trials (CVOTs) for different medicine classes for patient with type 2 diabetes.

LEARNING OBJECTIVES

On completion of this module, you will:

• Be familiar with the association between type 2 diabetes and cardiovascular complications
• Be aware of the evidence from the cardiovascular outcomes trials of agents used in the management of type 2 diabetes
• Understand the latest guidance for the pharmacological management of type 2 diabetes
• Appreciate the importance of a patient-centred approach to management

This module is one of a series of five. Others in the series are:

• Targets for glycaemic control in type 2 diabetes
• Tailoring therapy to the individual patient
• Short-term complications of type 2 diabetes
• Renal considerations in patients with type 2 diabetes

This resource is provided at an intermediate level. Read the article and answer the self-assessment questions, and reflect on what you have learned.

Complete the resource to obtain a certificate to include in your revalidation portfolio. You should record the time spent on this resource in your CPD log.

References

1. Davies MJ, D’Alessio D, Fradkin J. Management of hyperglycemia in T2DM, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018;41:2669-2701

2. Buse JB, Wexler DJ, Tsapas A. 2019 Update to: Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2020;43(2):487–493

3. Consentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2020;41:255–323