Management of Diabetes Mellitus

  • Alicia J. JenkinsEmail author
  • Emma Scott
  • Jordan Fulcher
  • Gary Kilov
  • Andrzej S. Januszewski
Part of the Contemporary Cardiology book series (CONCARD)


Due to the epidemic of Type 2 diabetes related to increased adiposity and sedentary lifestyles and the increasing incidence and improved prognosis of Type 1 diabetes, the primary care clinician (general practitioner) is likely to care for many people with diabetes during their career, the majority of whom will have Type 2 diabetes. The prevention, early diagnosis, and excellent management of diabetes are key to reducing the patient’s risk of diabetes complications. The chronic complications of diabetes relate to damage to the small and large vasculature and nerves, leading to diabetic retinopathy, nephropathy, and neuropathy; and accelerated atherosclerosis, leading to coronary artery disease (CAD), cerebrovascular disease, and peripheral vascular disease. People with diabetes who develop its microvascular complications are at particularly high risk of developing cardiovascular disease, which is the cause of death of over 60% of people with diabetes and is often silent. For the primary and secondary prevention of cardiovascular disease in people with diabetes (and the related microvascular complications), multiple risk factors need to be assessed and managed, including lifestyle (diet, exercise, and non-smoking), adiposity, glycemia and insulin resistance, blood pressure (BP), lipids, and vaccinations. Regular screening and treating vascular risk factors to proven targets are important. Clinical trials and meta-analyses provide evidence of the efficacy of many beneficial treatments for the primary and secondary prevention of diabetes-related vascular damage, yet often less than 10% of people with diabetes meet all recommended treatment targets. The primary care physician is ideally placed to manage diabetes, both directly and via assembling and coordinating a multidisciplinary team with the common goal of improving the quantity and quality of life of their patient with diabetes.


Diabetes mellitus Cardiovascular disease Risk factor management Primary prevention Secondary prevention Atherosclerosis Microvascular complications 



Scandinavian Simvastatin Survival Study


Action to Control Cardiovascular Risk in Diabetes


Angiotensin-converting enzyme


Albumin–creatinine ratio


American Diabetes Association


Australian Diabetes Society


Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation


Advanced glycation end-products




Angiotensin receptor blocker


Atherosclerosis Risk in Communities


Anglo-Scandinavian Cardiac Outcomes Trial


Blood pressure


Coronary artery calcium


Coronary Artery Calcification in Type 1 Diabetes study


Coronary artery disease


Collaborative Atorvastatin Diabetes Study


Cholesterol and Recurrent Events


Chronic kidney disease




Cholesterol Treatment Trialists’ Collaboration


Cardiovascular disease


Dietary Approaches to Stop Hypertension


Diabetes Control and Complications Trial


Diabetes Prevention Program


European Association for the Study of Diabetes


Epidemiology of Diabetes Intervention and Complications


estimated glomerular filtration rate




End-stage renal disease




Early Treatment Diabetic Retinopathy Study


Fenofibrate Intervention and Event Lowering in Diabetes


Flow-mediated dilation


Glomerular filtration rate


High-density lipoprotein cholesterol


Hydroxymethylglutaroyl coenzyme A


Heart Protection Study


International Diabetes Federation


Intima-media thickness


Japanese Prevention of Atherosclerosis with Aspirin for Diabetes


Low-density lipoprotein cholesterol


Myocardial infarction


Protein kinase C


Prevention of progression of arterial disease and diabetes


Peroxisome proliferator-activated receptor


Pulse wave velocity


Renin-angiotensin-aldosterone system


Royal Australian College of General Practitioners


Systemic lupus erythematosus


UK Prospective Diabetes Study


Veterans Affairs Diabetes Trial


Vascular endothelial growth factor


Very low-density lipoprotein



AJJ was supported by a NHMRC Practitioner Fellowship and grants from the University of Sydney, the Sydney Medical School Foundation, and the NHMRC Clinical Trials Centre. ES was supported by grants from the Australian Research Council, the University of Sydney, the Juvenile Diabetes Research Foundation Australia, and the Royal Australasian College of Physicians.

This book chapter is dedicated to the memory of our friend and colleague, Dr. Kevin Rowley, PhD (1964–2016), a multitalented, community-minded biomedical scientist, biostatistician, epidemiologist, and health advocate who helped us understand and contribute to improving equitable health access and health outcomes for people at high CVD risk, including people with diabetes and Indigenous Australians.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alicia J. Jenkins
    • 1
    • 2
    • 3
    Email author
  • Emma Scott
    • 1
  • Jordan Fulcher
    • 1
  • Gary Kilov
    • 4
  • Andrzej S. Januszewski
    • 1
    • 2
  1. 1.NHMRC Clinical Trials CentreUniversity of SydneyCamperdownAustralia
  2. 2.University of Melbourne, Department of MedicineMelbourneAustralia
  3. 3.Department of Diabetes and EndocrinologySt. Vincent’s HospitalFitzroyAustralia
  4. 4.University of Melbourne, Department of General PracticeMelbourneAustralia

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