PHARMACOLOGICAL TREATMENT OF DIABETIC-PATIENTS WITH CARDIOVASCULAR COMPLICATIONS

Cardiovascular complications are frequently present in insulin-depende nt (IDDM) and non-insulin dependent diabetes mellitus (NIDDM) patients and confer a very poor prognosis. In this overview we critically anal yse the current literature with regard to the benefits and also the po ssible harms of the available pharmacological treatment strategies in these patients. Te date. insulin is the only hypoglycaemic agent which has been proven both effective and safe in NIDDM patients with cardio vascular complications. Also, several trials indicate that treatment w ith oral hypoglycaemic agents may confer a substantial risk in such pa tients. Conventional antihypertensive treatment, including betablocker s and diuretics, has been convincingly shown to : educe mortality and morbidity in diabetic nephropathy and in NIDDM patients. However, this may not :be the case with newer antihypertensive agents, such as angi otensin-converting enzyme (ACE) inhibitors and calcium channel blocker s, Likewise, convincing evidence is lacking that these newer antihyper tensive agents provide meaningful clinical benefit when compared to th e conventional treatment regarding slower progression of diabetic neph ropathy or their impact on lipid and glucose metabolism. Cholesterol l owering therapy with statins and aspirin treatment have also been repe atedly shown to improve the prognosis of diabetic patients with corona ry heart disease.