Should the coronary diabetic patient benefit from specific management? Theviewpoint of the diabetologist.

Type 2 diabetes is a strong independent risk factor for coronary heart dise ase, which is responsible for at least 50 % of deaths in this disease. Afte r acute myo cardial infarction, mortality in diabetic patients is twice tha t observed in non-diabetic patients. This high mortality is partly related to poor care. Thrombolysis, cardioselective beta-blockers and angiotensin-c onverting enzyme inhibitors are more effective in reducing cardiovascular m orbidity and mortality in diabetic than non-diabetic patients, and strict g lycaemic control can decrease mortality significantly. Secondary prevention by pharmacological and non-pharmacological means is also very effective in diabetic patients with coronary heart disease, although often poorly used by patients and physicians. Diabetic patients with stable angina or silent myocardial ischaemia should be diagnosed early in the course of the disease , ii necessary by non-invasive investigation. The diagnosis of coronary hea rt disease in diabetic patients may lead to modifications in treatment goal s and modalities. As the prevalence of diabetic patients with coronary hear t disease is increasing, it might be feasible to establish special cardiodi abetic units in which they could benefit from close daily cooperation betwe en diabetologists and cardiologists.