At a session yesterady the experts said the risk factors should be better more intensively treated.
European guidelines yhis year recommends a routine HbA1c in alla patients with ST elevation myocardial infarction and non-ST elevation acute coronary syndrome.
Many guidelines recommend systolic blood pressure for diabtic patients 140 mm Hg, but in light of recent trials, the next round of guidelines will likely recommend 12 or 130 mm Hg as the goal, said prof Cushman, Tennessee Health Science Center in US. "Canadian guidelines already recommend 130 mm Hg this year".
Most guidelines recommend agentys from one av these 4 classes; thiazides, calcioum channel blockers, ACEs and ARBs. All four have been found to be effective in reducing cardiovascular events in diabetes, although thiazide diuretics provide greater cardiovascular benefits, Individuals with any degree of kidney disease will also have great benefit from an ACE or ARB, said prof Cushman. Africans show less cardiovascular benefits from ACE and ARB compared to other antihypertensives, but they should be given in kidney disease in this population, according to Cushman, and stressed that ARB and ACE should not be given together because too large risks of side effects. And there is now contra-indications to use antihypertensives in patients with SGLT2 inhibitors.
Amputations should not be a feature of diabetes. Every year check fott status and the pulses, and ifa fott ulceration the arterial system should be investigated for vessel surgery.
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