A STRATEGY FOR ARTERIAL RISK ASSESSMENT AND MANAGEMENT IN TYPE-2 (NON-INSULIN-DEPENDENT) DIABETES-MELLITUS

People with Type 2 (non-insulin-dependent) diabetes mellitus die mainl y from cardiovascular and cerebrovascular disease. Furthermore, the ma jor burden of their symptoms arise from arterial disease, including pe ripheral vascular disease. However, management guidelines for Type 2 d iabetes continue to focus on blood glucose control, which is only one of a number of arterial risk factors found with this type of diabetes. Clinically it is evident that blood glucose control continues to occu py centre-stage in the management of Type 2 diabetes as practised by m any physicians. Even when arterial risk factors such as smoking or rai sed serum triglycerides are noted, their management is often relativel y neglected. As part of the St Vincent Declaration Action Programme, a working group has sought consensus on the number and relative importa nce of arterial risk factors requiring management in quality diabetes care. The group seeks to assist those devising protocols and guideline s, records and quality systems, and those charged with directly advisi ng and educating people with diabetes. Arterial risk factors that can be routinely identified and monitored, and modified by application of management protocols, include high blood pressure, high serum total an d LDL cholesterol, low serum HDL cholesterol and raised serum triglyce rides, poor blood glucose control, smoking, high body mass index and b ody fat distribution. Aspirin can modify hypercoagulability, but this is not easily monitored. Arterial risk factors that cannot be modified , but which have an impact on the intensity of management of other fac tors, include ethnic group, gender, and family history of arterial dis ease. Raised albumin excretion is an arterial risk factor and can be m odified, but it is not clear whether this reduces cardiovascular risk. For many of the risk factors, levels of high, medium, and low risk ca n be set. These can be used, in consultation with the patient, to dete rmine appropriate interventions and provide feedback on risk reduction resulting from successful management. (C) 1997 by John Wiley & Sons, Ltd.