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Diabet Med. 1997 Jul;14(7):611-21.

A strategy for arterial risk assessment and management in type 2 (non-insulin-dependent) diabetes mellitus. European Arterial Risk Policy Group on behalf of the International Diabetes Federation European Region.

[No authors listed]


People with Type 2 (non-insulin-dependent) diabetes mellitus die mainly from cardiovascular and cerebrovascular disease. Furthermore, the major burden of their symptoms arise from arterial disease, including peripheral vascular disease. However, management guidelines for Type 2 diabetes continue to focus on blood glucose control, which is only one of a number of arterial risk factors found with this type of diabetes. Clinically it is evident that blood glucose control continues to occupy centre-stage in the management of Type 2 diabetes as practised by many physicians. Even when arterial risk factors such as smoking or raised serum triglycerides are noted, their management is often relatively neglected. As part of the St Vincent Declaration Action Programme, a working group has sought consensus on the number and relative importance of arterial risk factors requiring management in quality diabetes care. The group seeks to assist those devising protocols and guidelines, records and quality systems, and those charged with directly advising and educating people with diabetes. Arterial risk factors that can be routinely identified and monitored, and modified by application of management protocols, include high blood pressure, high serum total and LDL cholesterol, low serum HDL cholesterol and raised serum triglycerides, poor blood glucose control, smoking, high body mass index and body fat distribution. Aspirin can modify hypercoagulability, but this is not easily monitored. Arterial risk factors that cannot be modified, but which have an impact on the intensity of management of other factors, include ethnic group, gender, and family history of arterial disease. Raised albumin excretion is an arterial risk factor and can be modified, but it is not clear whether this reduces cardiovascular risk. For many of the risk factors, levels of high, medium, and low risk can be set. These can be used, in consultation with the patient, to determine appropriate interventions and provide feedback on risk reduction resulting from successful management.

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