Comprehensive management of patients with type 2 diabetes: Establishing priorities of care

Type 2 diabetes is a complex metabolic disc der characterized by elevated b lood glucose levels and a marked increase in the risk of cardiovascular dis ease (CVD). The increased CVD risk is caused by a unique cluster of metabol ic abnormalities, including dyslipidemia, hypertension, insulin resistance, and hyperglycemia. To reduce the risk of cardiovascular complications in patients with type 2 diabetes, comprehensive management of risk factors is essential. Aggressive treatment of dyslipidemia and hypertension is known to benefit patients wi th type 2 diabetes. In addition, intensive glycemic control and targeted tr eatment of insulin resistance can further reduce the enormous burden of CVD in this high-risk population. Increasing evidence suggests that insulin re sistance is one of the earliest markers of risk for both CVD and diabetes, and it is known that insulin resistance alone can significantly increase th e risk of CVD, Type 2 diabetes and insulin resistance are both associated w ith disordered lipid metabolism, manifest in elevated triglyceride levels, low levels of high-density lipoprotein cholesterol, and small, dense low-de nsity lipoprotein cholesterol particles. Patients with type 2 diabetes and insulin resistance have an increased risk of hypertension, which further co ntributes to their CVD risk. Each of these factors can also contribute to t he risk of microvascular disease. To ensure that patients with type 2 diabetes receive comprehensive, high-qu ality care, specific standards have been developed. These standards can hel p providers establish clear treatment targets, identify specific priorities of care, and use therapies of known efficacy to reduce the risk of complic ations. This review summarizes the current standards of care for patients w ith type 2 diabetes, with an emphasis on treatments that reduce the cardiov ascular risk factors. Using a case study approach, it reviews the essential components of diabetes care and proposes a rational approach to these comp lex cases-an approach that should result in consistent, high-quality care.