Recent Medical Treatment of Diabetes Mellitus : Prevention and Cardiovascular Complications / The Japanese Journal of Rehabilitation Medicine

ABSTRACT

Type 2 diabetes mellitus (DM) doubles the risk of major cardiovascular complications in both patients with and those without established cardiovascular disease (CVD), and the majority of patients with DM die of CVD. Therefore, prevention and early diagnosis for CVD are important for the improvement of quality of life and prognosis of patients with DM. Exercise stress tests, such as a treadmill test, are needed to detect myocardial ischemia, but such stress testing should be done by cardiologists. On the other hand, measurement of ankle brachial index (ABI) is quick and easy and has been used successfully to diagnose peripheral artery disease. Since ABI is known to be a good predictor of the risk of recurrent CV events and death, I strongly recommend that ABI be measured in all DM patients. Dipeptidyl peptidase 4 (DPP-4) inhibitors are oral agents with little risk of hypoglycemia and thus used widely. In 2013, two clinical studies (EXAMINE and SAVOR-TIMI53) showed that DPP-4 inhibitors were generally safe and well-tolerated but did not decrease or increase the rate of CV events in patients with high risk for CV. Although the study periods were short (1.5-2.0 years), it was shown that a reduction of CV events in DM patients with CV risk is difficult with glycemic control alone. Results of the Steno-2 study showed that optimal treatment of hypertension and dyslipidemia in addition to glycemic control are needed to reduce CV events.