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Management of Diabetes Mellitus

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Comprehensive Cardiovascular Medicine in the Primary Care Setting

Part of the book series: Contemporary Cardiology ((CONCARD))

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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.

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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

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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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Authors and Affiliations

  1. NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Sydney, Australia

    Alicia J. Jenkins, Emma Scott, Jordan Fulcher & Andrzej S. Januszewski

  2. University of Melbourne, Department of Medicine, Melbourne, VIC, Australia

    Alicia J. Jenkins & Andrzej S. Januszewski

  3. Department of Diabetes and Endocrinology, St. Vincent’s Hospital, Fitzroy, Melbourne, Australia

    Alicia J. Jenkins

  4. University of Melbourne, Department of General Practice, Melbourne, VIC, Australia

    Gary Kilov

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  1. Alicia J. Jenkins
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  2. Emma Scott
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  3. Jordan Fulcher
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  5. Andrzej S. Januszewski
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Correspondence to Alicia J. Jenkins .

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Editors and Affiliations

  1. Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Peter P. Toth

  2. Cardiovascular Division, Harvard Medical School Brigham & Women’s Hospital, Boston, MA, USA

    Christopher P. Cannon

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Jenkins, A.J., Scott, E., Fulcher, J., Kilov, G., Januszewski, A.S. (2019). Management of Diabetes Mellitus. In: Toth, P., Cannon, C. (eds) Comprehensive Cardiovascular Medicine in the Primary Care Setting. Contemporary Cardiology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-97622-8_7

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  • DOI: https://doi.org/10.1007/978-3-319-97622-8_7

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