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Intense Management of Diabetes Mellitus: Role of Glucose Control and Antiplatelet Agents

From the Section of Diabetes/Endocrinology, VA San Diego HealthCare System, and the University of California at San Diego.

Type 2 diabetes has now reached epidemic proportions across the world and is the cause of substantial morbidity and mortality. Patients with diabetes suffer from their mircovascular complications of retinopathy (blindness), nephropathy (renal failure, dialysis), and neuropathy (neropathic pain, trophic ulcers). However, ultimately, the majority of diabetics will die from macrovascular cardiovascular disease. Not only does cardiovascular disease develop earlier in the presence of diabetes, mortality from cardiovascular disease is increased by a factor of two to three in persons with diabetes as compared with the general population. To reduce this increased risk, a multifactorial approach to the management of type 2 diabetes has been advocated. The American Diabetes Association recommends not only good glycemic control but also identification and aggressive treatment of associated cardiovascular risk factors, with more stringent target levels for lipids and blood pressure than those recommended for the general population. Studies have shown that an intensified and goal-oriented approach to the treatment of type 2 diabetes addressing tight glucose control, optimal lipid and blood pressure management and the use of antiplatelet agents like aspirin reduces cardiovascular events, as well as nephropathy, retinopathy, and neuropathy.

Key Words: Type 2 diabetes • intensive treatment • glucose control • antiplatelet agents

Address for reprints: Dr. Mudaliar, VA San Diego HealthCare System (Mail Code: V111G), 3350 La Jolla Village Drive, San Diego, CA 92161.

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