Diabetes and the heart

Excerpt

It was 10 years ago that the process of convergence between vascular and metabolic medicine was addressed in the first issue of the journal Herz dedicated to the topic“Diabetes and the Heart” in 2004. Now, with the fifth edition on this subject, significant progress has been made through the updated joint guidelines of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD) dedicated to“Diabetes, Pre-Diabetes and Cardiovascular Diseases.” In 2007 we called it a major breakthrough that both societies came up with joint guidelines emphasizing both the metabolic and the vascular needs of diabetes patients with heart problems. Although much appreciated, these were definitely the least followed guidelines ever. The translation from scientific-based decision making into clinical routine was hardly possible under real-life conditions, as far as diagnostic or therapeutic dimensions were concerned. It took another 6 years to produce the first update, which was recently released during the annual ESC Meeting in Amsterdam. The core investigational algorithm outlining the“principles for diagnosis and management of cardiovascular disease in diabetes mellitus patients with the primary diagnosis of diabetes or a primary diagnosis of cardiovascular disease” remained almost the same, but 11 robust recommendations were added. These comprise pathophysiological considerations, early diagnosis, prevention, risk assessment, risk factor management, lifestyle intervention, preventative target values (blood pressure below 140/85 mmHg, LDL cholesterol below 1.8 mmol, HbA_1c below 7%), multifactorial medical management, revascularization options, heart failure treatment, and, finally, multidisciplinary strategies involving medical subspecialties along with nurses, dieticians, podiatrists, physical therapists, and other health-care professionals. It is particularly valuable that, among others, management of arrhythmias, predominantly atrial fibrillation, is included in the cardiovascular disease continuum of patients with diabetes mellitus. Apparently, the scientific evidence-based guidelines are converted into a multidisciplinary translational document with the primary goal of changing care processes and of overcoming resistance lines forming a multiprofessional alliance for the patient’s well-being. …