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Management of Diabetes Mellitus

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

Abstract

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.

Keywords

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

Abbreviations

4S

Scandinavian Simvastatin Survival Study

ACCORD

Action to Control Cardiovascular Risk in Diabetes

ACE

Angiotensin-converting enzyme

ACR

Albumin–creatinine ratio

ADA

American Diabetes Association

ADS

Australian Diabetes Society

ADVANCE

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

AGEs

Advanced glycation end-products

Apo

Apolipoprotein

ARB

Angiotensin receptor blocker

ARIC

Atherosclerosis Risk in Communities

ASCOT

Anglo-Scandinavian Cardiac Outcomes Trial

BP

Blood pressure

CAC

Coronary artery calcium

CACTI

Coronary Artery Calcification in Type 1 Diabetes study

CAD

Coronary artery disease

CARDS

Collaborative Atorvastatin Diabetes Study

CARE

Cholesterol and Recurrent Events

CKD

Chronic kidney disease

COX-1

Cyclooxygenase-1

CTTC

Cholesterol Treatment Trialists’ Collaboration

CVD

Cardiovascular disease

DASH

Dietary Approaches to Stop Hypertension

DCCT

Diabetes Control and Complications Trial

DPP

Diabetes Prevention Program

EASD

European Association for the Study of Diabetes

EDIC

Epidemiology of Diabetes Intervention and Complications

eGFR

estimated glomerular filtration rate

EKG

Electrocardiogram

ESRD

End-stage renal disease

ET-1

Endothelin-1

ETDRS

Early Treatment Diabetic Retinopathy Study

FIELD

Fenofibrate Intervention and Event Lowering in Diabetes

FMD

Flow-mediated dilation

GFR

Glomerular filtration rate

HDL-C

High-density lipoprotein cholesterol

HMG-CoA

Hydroxymethylglutaroyl coenzyme A

HPS

Heart Protection Study

IDF

International Diabetes Federation

IMT

Intima-media thickness

JPAD

Japanese Prevention of Atherosclerosis with Aspirin for Diabetes

LDL-C

Low-density lipoprotein cholesterol

MI

Myocardial infarction

PKC

Protein kinase C

POPADAD

Prevention of progression of arterial disease and diabetes

PPAR

Peroxisome proliferator-activated receptor

PWV

Pulse wave velocity

RAAS

Renin-angiotensin-aldosterone system

RACGP

Royal Australian College of General Practitioners

SLE

Systemic lupus erythematosus

UKPDS

UK Prospective Diabetes Study

VADT

Veterans Affairs Diabetes Trial

VEGF

Vascular endothelial growth factor

VLDL

Very low-density lipoprotein

Notes

Acknowledgments

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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