The prevalence of diabetes mellitus is 5–10% of the general population, with type 2 being more frequent. The additional problem is underdiagnosis, as 50% of these patients are not diagnosed. The magnitude of the problem increases as it is associated with other diseases like congestive heart failure and COPD. It is an important cardiovascular risk factor leading to high morbidity and mortality.
The proportion of patients with heart disease and type 1 diabetes is low, around 0.8% to 1%. Clinical manifestations are polyuria, polydipsia, weight loss and polyphagia when they present with a decompensation. A very small percentage of patients develop diabetic ketoacidosis.
Assess risk
The most widely used scale for assessing cardiovascular risk is SCORE, which allows estimation of the 10-year risk of the first fatal atherosclerotic complication: acute myocardial infarction, cerebrovascular accident, any peripheral arterial complication, or Sudden death, based on risk factors for the following factors, such as age, gender, smoking, systolic blood pressure, and total cholesterol. However, it does not cover diabetes.
Risk equation constructed from the UK Prospective Diabetes Study (UKPDS Risk Engine) which was the first predictive model of cardiovascular disease in men and women with type 2 diabetes mellitus. The model also includes the classic cardiovascular risk factor of HbA1c as a measure of glycemia. Control and duration of diabetes.
A new version of the model has been developed that partially resolves that it can only be used in people with recently diagnosed type 2 diabetes and does not include albuminuria. The UKPDS Outcome Model 2 (UKPDS-OM2) simulates 25 years of health outcomes in people with type 2 diabetes using data from 30 years of the Outcome Model 2 study.
To date this model has not been externally validated and its use is limited to clinical trials or research projects.
Higher risk
People with diabetes are at increased risk of atherosclerotic vascular disease, and good control of total and LDL cholesterol levels is essential to prevent macrovascular complications.
Clean-diet measures should be promoted, with a decrease in the consumption of saturated fat and trans fatty acids, while increasing the consumption of omega 3 fatty acids and plant sterols.
The typical lipid pattern of type 2 diabetes includes an increase in triglyceride concentration, a decrease in high-density lipoprotein cholesterol levels, and an increase in the number of small and dense low-density lipoproteins.
Lipid target
Lipid targets in patients with diabetes are established based on cardiovascular risk according to the ESC/EAS guidelines. Patients with type 2 diabetes with target organ involvement (microalbuminuria, retinopathy or neuropathy), or ≥3 RFs, or diabetes 1 >20 years of development are at very high risk. Control The therapeutic goal is cLDL <55 mg/dl.
Type 2 diabetes without target organ damage in high-risk patients is diabetes more than 10 years of development without other risk factors. The control target for this subgroup is LDL-C <70 mg/dL.
Patients with type 1 diabetes <35 years or diabetes 2 <50 years with less than 10 years of growth and no other risk factors are considered moderate risk. Your LDL-C goal <100 mg/dL.
Patients with very high cardiovascular risk are candidates for increasing treatment intensity, adding a higher potency statin or ezetimibe or iPCSK9.
In the rest of the diabetic population, combination therapy should be initiated when lipid control targets cannot be reached.
The collaboration of doctors specializing in Family and Community Medicine Alberto Granskog Sierra, Isabel Rodríguez Escobar, Jorge Teruel Ríos, José Antonio Sánchez Agar and Antonio Zaragoza González from the Nonduodermic Health Center contributed to the preparation of this article; Ángeles Aragón Martínez, José Martínez Asensio, Amalio Paredes Fernández-Delgado, José Antonio Pina Pellegrin, Ramón Gallego Navarrete and Pedro Pérez Martínez from the Alcantarilla Casco Health Center, and Gabriel Gómez Martínez, Motos Díaz, Clara Gómez García, Julio Yeh Garcia, Alfonso Navajo Sanz and Antonio Marcos Nuñez, from the Ciza Health Center, all in Murcia.
