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!y"e diabetes
;-cell destr'ction
!y"e $ diabetes
Dr'g- or c8emical-ind'ced
Dy"oglycemic e"isodes
H Dy"oglycemia a3areness
H Any severe 8y"oglycemia: fre2'ency and ca'se
Co%,onents of t'e Co%,"e'ensive
Co%,onents of t'e Co%,"e'ensive
Diabetes Eval-ation .0/
Diabetes Eval-ation .0/
ADA. ,. Diabetes Care. Diabetes Care $.934(s'""l ):S0. !able B.
C'rrent treatment of diabetes4 incl'ding
medications4 meal "lan4 "8ysical activity "atterns4
and res'lts of gl'cose monitoring and "atientIs 'se
of data ($)
?'ndosco"ic e6amination@
!8yroid "al"ation
Dental e6amination
Significant red'ction of AC
Simvastatin $.-4.
mg vs. "lacebo
B%.0 to
43.$>
%.> 4$.%>
B* to +
(3*>)
AS#EN
$
Atorvastatin . mg
vs. "lacebo
3+.% to
$4.%>
34> $.0>
$ to 0+
($+>)
D#S-D&
3
Simvastatin 4. mg
vs. "lacebo
43.B to
3*.3>
0> 0.%>
$3 to B4
(3>)
CARE-D&
4
#ravastatin 4. mg
vs. "lacebo
4..B to
3%.4>
3> %.4>
3* to ++
($0>)
!N!-D&
%
Atorvastatin B. mg
vs. . mg
$*.3 to
$.*>
B> 4.0>
++ to 00
($$>)
ADA. ,I. #revention4 &anagement of Com"lications. Diabetes Care $.934(s'""l ):S3.. !able .
@End"ointsOCDD deat84 nonfatal &I
Secondary Prevention
St-d$
"ef&
Statin dose and
o%,a"ato"
Ris:
"ed-tion
Relative
"is:
"ed-tion
Absol-te
"is:
"ed-tion
LDL
'oleste"ol
"ed-tion*
%#3dl .?/
D#S-D&
Simvastatin 4. mg
vs. "lacebo
0.% to
.%>
34> *..>
$4 to B*
(3>)
CARDS
$
Atorvastatin . mg
vs. "lacebo
.% to
0.%>
3%> 4..>
B to 0
(4.>)
AS#EN
3
Atorvastatin . mg
vs. "lacebo
+.B to
0.+>
+> .+>
4 to B.
(3.>)
ASC<!-D&
4
Atorvastatin . mg
vs. "lacebo
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@End"ointsOCDD deat84 nonfatal &I
ADA. ,I. #revention4 &anagement of Com"lications. Diabetes Care $.934(s'""l ):S3.. !able .
Primary Prevention
Statins) Red-tion in 109+ea" Ris: of
Statins) Red-tion in 109+ea" Ris: of
Ma=o" C2D
Ma=o" C2D
> >
in (atients 8it' Diabetes
in (atients 8it' Diabetes
Reo%%endations) !l$e%i* Blood
Reo%%endations) !l$e%i* Blood
("ess-"e* Li,id Cont"ol in Ad-lts
("ess-"e* Li,id Cont"ol in Ad-lts
AC G0..>
@
7lood "ress're G3.-B. mmDg
N
1i"ids
1D1 c8olesterol G.. mg-dl
(G$.* mmol-l)
P
@&ore or less stringent glycemic goals may be a""ro"riate for individ'al "atients. Goals s8o'ld be
individ'ali5ed based on: d'ration of diabetes4 age-life e6"ectancy4 comorbid conditions4 Ano3n C,D or
advanced microvasc'lar com"lications4 8y"oglycemia 'na3areness4 and individ'al "atient
considerations.
N7ased on "atient c8aracteristics and res"onse to t8era"y4 8ig8er or lo3er systolic blood "ress're targets
may be a""ro"riate.
PIn individ'als 3it8 overt C,D4 a lo3er 1D1 c8olesterol goal of G0. mg-dl (.B mmol-l)4 'sing a 8ig8
dose of statin4 is an o"tion.
ADA. ,I. #revention4 &anagement of Com"lications. Diabetes Care $.934(s'""l ):S3. !able $.
Reo%%endations)
Reo%%endations)
Anti,latelet A#ents .1/
Anti,latelet A#ents .1/
Consider as"irin t8era"y (0%H*$ mg-day) (C)
As a "rimary "revention strategy in t8ose 3it8 ty"e or ty"e $
diabetes at increased cardiovasc'lar risA (.-year risA F.>)
Incl'des most men F%. years of age or 3omen F*. years of age
38o 8ave at least one additional maKor risA factor
?amily 8istory of C,D
Dy"ertension
SmoAing
Dysli"idemia
Alb'min'ria
ADA. ,I. #revention4 &anagement of Com"lications. Diabetes Care $.934(s'""l ):S3.
Reo%%endations)
Reo%%endations)
Anti,latelet A#ents .2/
Anti,latelet A#ents .2/
As"irin s8o'ld not be recommended for C,D "revention for
ad'lts 3it8 diabetes at lo3 C,D risA4 since "otential adverse
effects from bleeding liAely offset "otential benefits (C)
.-year C,D risA G%>: men G%. and 3omen G*. years of age
3it8 no maKor additional C,D risA factors
In "atients in t8ese age gro'"s 3it8 m'lti"le ot8er risA
factors (e.g.4 .-year risA %>-.>) clinical K'dgment is
re2'ired (E)
ADA. ,I. #revention4 &anagement of Com"lications. Diabetes Care $.934(s'""l ):S3.
Reo%%endations)
Reo%%endations)
Anti,latelet A#ents .0/
Anti,latelet A#ents .0/
Ese as"irin t8era"y (0%H*$ mg-day)
Secondary "revention strategy in t8ose 3it8 diabetes 3it8 a
8istory of C,D (A)
?or "atients 3it8 C,D4 doc'mented as"irin allergy
Clo"idogrel (0% mg-day) s8o'ld be 'sed (7)
Combination t8era"y 3it8 ASA (0%H*$ mg-day) and
clo"idogrel (0% mg-day)
Reasonable for '" to a year after an ac'te coronary syndrome (7)
ADA. ,I. #revention4 &anagement of Com"lications. Diabetes Care $.934(s'""l ):S3.
Reo%%endations)
Reo%%endations)
S%o:in# Cessation
S%o:in# Cessation
#resence of retino"at8y
Dietary intervention
ACE in8ibitors
Goal of treatment