Type 2 Diabetes

More and more people are developing diabetes worldwide, and the most common form of diabetes (over 97% of all cases) is type 2 diabetes. A high percentage of patients (65 to 80%) with type 2 diabetes will die from cardiovascular disease (CVD). Although mortality from CVD has been declining in some countries, such has not been the case for diabetic patients. Overall, the absolute risk of coronary heart disease death is roughly three times higher in diabetic patients than in non-diabetic patients. In diabetic patients, heart disease manifests as macrovascular and microvascular complications as well as a series of metabolic abnormalities such as impaired plasma glucose-insulin homeostasis. In this regard, although elevated fasting blood glucose is strongly indicative of type 2 diabetes risk, it plays a lesser role in predicting CVD risk. Evidence available suggests that the clustering risk factors observed in type 2 diabetic patients largely account for their high rates of cardiovascular morbidity and mortality.

Key Points

• Many patients with type 2 diabetes are at high risk of CVD. This increased risk is often similar to that of non-diabetic patients who have experienced myocardial infarction.
• A wealth of evidence indicates that hyperglycemia is a significant contributor—but not the sole contributor—to the increased CVD risk that comes with diabetes.
• Intensive blood glucose control reduces microvascular complications but does not have a substantial effect on macrovascular disease in patients with type 2 diabetes.
• The metabolic syndrome is very common in diabetic patients, and those with diabetes and the metabolic syndrome have the highest CHD rates.
• Evidence is mounting that it is not the hyperglycemic state per se that has the biggest impact on CVD in type 2 diabetes but rather the clustering of abdominal obesity-related risk factors. These factors may be responsible for the high incidence of cardiovascular events in diabetes.

Read more on Hyperglycemia, Type 2 Diabetes and CVD Risk.

Key Points

• Type 2 diabetes is a significant CVD risk factor. However, the independent contribution of hyperglycemia per se to CVD risk remains uncertain.
• The hyperglycemic state of diabetes is only one of the dysmetabolic components observed in patients, who are often abdominally obese.
• The cluster of atherogenic metabolic abnormalities now often referred to as the metabolic syndrome is known to increase the risk of type 2 diabetes and CVD.
• Intervention trials have shown that reducing body weight in overweight and obese subjects at high risk of developing diabetes could substantially reduce their risk of developing diabetes.
• Age is also an important factor to consider when evaluating the CVD risk of diabetic patients.

Read more on CVD Risk and Type 2 Diabetes: Beyond Hyperglycemia.