Diabetes, prediabetes and cardiovascular risk

The increase in the incidence of diabetes and prediabetes, the association with cardiovascular disease and the accompanying high morbidity and mortality make glucose perturbations a serious public health issue. The poor prognosis among patients with type 2 diabetes and cardiovascular disease may relate to several factors. There seems to be a misconception among cardiologists that diabetes is a nonfrequent, almost unexciting disease and if it exists, it is labelled as 'mild' and/or 'easy to treat.' If screened with an oral glucose tolerance test approximately two-thirds of patients with coronary artery disease, stable and unstable, and earlier unknown glucometabolic perturbations indeed have impaired glucose tolerance or newly detected diabetes. Both conditions are related to an increase in cardiovascular mortality and morbidity. The European guidelines for diabetes, prediabetes and cardiovascular disease recommend that all patients with cardiovascular disease manifestations are screened with an oral glucose tolerance test. Many cardiologists seem more focused on the manifestation of the cardiac condition, not fully understanding the need for simultaneous and aggressive interactions directed towards the underlying metabolic disorder and the frequently existing concomitant risk factors. Treatment must be multifactorial and target driven. Treatment targets are stricter for patients with diabetes than those without diabetes. Patient management according to such standards is highly rewarding but necessitates transprofessional collaboration between cardiologists and diabetologists to be successfully accomplished. Eur J Cardiovasc Prev Rehabil 17 (Suppl 1): S9-S14 (C) 2010 The European Society of Cardiology