Focus on glycemic (blood sugar) control keeping your HbA1c levels below 7.0% to reduce the risk of the "microvascular" complications of diabetes, such as kidney failure, painful nerve problems, and decreased vision or even blindness.The cornerstone of treatment should be healthy lifestyle choices (a healthy diet and regular physical activity) and optimal control of blood pressure and lipids (such as cholesterol and triglycerides).  An aspirin regimen should be used under the advice of a physician in patients who have known cardiovascular disease due to atherosclerosis.With regards to glucose-lowering medications, Metformin should generally be the first choice, particularly in obese patients.  If it does not produce adequate HbA1c control, other medications can be considered, recognizing that the fund of knowledge about the effect of other glucose-lowering agents on cardiovascular risk is sparse.If a TZD (such as pioglitazone or rosiglitazone) is considered for this purpose, it should not be used with an expectation of benefit in reducing the occurrence of heart attack or stroke, and the rationale for the choice of a TZD should be discussed with your physician.  However, patients who have successfully achieved recommended HbA1c control on a TZD might consider remaining on their medication.  If the treating physician and/or the patient is uncomfortable with using a TZD, another medication could be substituted.  There is currently not enough data to support the choice of a specific TZD.

According to the joint advisory:

Diabetes mellitus is increasing in prevalence in the United States and worldwide.  An estimated 23.6 million people in the United States, 7.8% of the population, had diabetes in 2007, with more than 90% of cases being type 2 diabetes mellitus.Diabetes increases the risk of CVD events by 2- to 4-fold, and CVD accounts for nearly two thirds of deaths among diabetic patients.Among people who experience CVD events, diabetes is highly prevalent: 45% of those hospitalized for heart attack have known or previously undiagnosed diabetes.Diabetes is also an independent predictor of secondary adverse events, such as reinfarction, heart failure, and death.

Advisory writing committee members include Sanjay Kaul, M.D., Chair; Ann F. Bolger, M.D.; David Herrington, M.D.; Robert P. Giugliano, M.D., ScM and Robert H. Eckel, M.D.  Author disclosures are on the manuscript.

SOURCE American Heart Association