Risk Assessment and Risk Management for Patients with Diabetes Mellitus

Typ2

Type 2 diabetes mellitus doubles the risk of cardiovascular disease and reduces life expectancy by 4 to 6 years.
Patients with organ damage are at particularly high risk.
Risk factor management should be implemented for all patients with type 2 diabetes mellitus.
Only patients with a diabetes duration of less than ten years, no evidence of organ damage, and no additional cardiovascular risk factors have a moderate risk of developing cardiovascular disease.

Patients with Type 2 Diabetes Mellitus have a high risk of cardiovascular disease even when well controlled.
The higher the HbA1c, the higher the cardiovascular risk.
A few patients with a short duration of diabetes may not yet have secondary complications despite poor HbA1c control.
However, poorly controlled patients with type 2 diabetes mellitus have a very high risk of cardiovascular disease.
Accordingly, the LDL-C target should be < 55 mg/dl (< 1.4 mmol/l) and a reduction of ≥ 50% from baseline is indicated.

Large blood glucose fluctuations and hypoglycemia represent a significantly higher cardiovascular risk than elevated HbA1c alone.
Patients whose HbA1c levels vary greatly from visit to visit, and patients who experience severe hypoglycemia, have a significantly increased risk of cardiovascular disease and mortality.
Therefore, a diabetes therapy should be chosen that minimizes large fluctuations.

ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disea- se prevention in clinical practice. Eur Heart J. 2021 Sep 7;42(34):3227‒3337.