Globally, diabetes mellitus is a major threat to human health. The number of people with diabetes has increased alarmingly since 1985, and the rate of new cases is escalating. In 1985, an estimated 30 million people worldwide had diabetes; by 2003, it was estimated that approximately 194 million people had diabetes, and this figure is expected to increase to almost 350 million by 2025.1
The prevalence of diabetes is higher in developed countries than in developing countries, but the developing world will be hit the hardest by the diabetes epidemic in the future. Increased urbanization, westernization, and economic growth in developing countries have already contributed to a substantial increase in diabetes. Although diabetes is most common among the elderly in many populations, prevalence rates are increasing among young populations in the developing world.
Diabetes mellitus, whether type 1 or type 2, is a very strong risk factor for the development of coronary heart disease (CHD) and stroke2 (Table 91–1). Eighty percent of all deaths among diabetic patients are a result of atherosclerosis, compared with approximately 30% among nondiabetic persons. A large National Institutes of Health (NIH) cohort study revealed that heart disease mortality in the general US population is declining at a much greater rate than it is in diabetic subjects. In fact, diabetic women suffered an increase in heart disease mortality over that period.2 Among all hospitalizations for diabetic complications, >75% are a consequence of atherosclerosis. An increase in the prevalence of diabetes has been noted, which, in part, can be attributed to the aging of the population and an increase in the rate of obesity and sedentary lifestyle in the United States.
Table 91–1. Clinical Evaluation of Risk Factors for the Development of Cardiovascular Disease in Diabetic Patients |Favorite Table|Download (.pdf)
Table 91–1. Clinical Evaluation of Risk Factors for the Development of Cardiovascular Disease in Diabetic Patients
|Duration (if known); current and previous medications; assess presence of orthostatic hypertension|
|Serum lipids and lipoproteins|
|Dietary habits, alcohol intake, amount of exercise and whether aerobic|
|Family history of dyslipidemia, eruptive xanthoma, lipemia, retinalis, xanthelasma; thyroid function tests|
|LDL, HDL, cholesterol, fasting triglycerides|
|Spot albumin-to-creatinine ratio (in micro- and macroalbuminuria)|
|Do not rely on dipstick protein because negative results may reflect lack of sensitivity of test|
|Duration of diabetes; family history of diabetes; vascular, renal, and retinal complications|
|Laboratory: FPG, hemoglobin A1c every 3 mo; diagnosis: FPG >126 × 2, hemoglobin A1c > 6.5%,3 impaired fasting glucose 110-126 × 2; when in doubt, have patient undergo 2-h oral glucose tolerance test|
Diabetes accelerates the natural course of atherosclerosis in all groups of patients and involves a greater number of coronary vessels with more diffuse atherosclerotic lesions (Fig. 91–1). Cardiac catheterizations in diabetic ...