Early recognition and treatment of glucose abnormalities to prevent type 2diabetes mellitus and coronary heart disease

Striking parallels exist in both risk and protective factors between corona ry heart disease and type 2 diabetes mellitus. Patients with insulin resist ance are more likely to develop diabetes and coronary heart disease. Better treatment of diabetes may result in less coronary heart disease, although this has not yet been established. Reliance on fasting glucose determinatio ns alone will overlook a substantial number of patients at risk for diabete s and subsequent coronary heart disease. Measurement of glycosylated hemogl obin should be a routine part of screening for patients at risk for diabete s. Patients with glycosylated hemoglobin levels in the high-normal range sh ould be treated more aggressively with diet, exercise, and medication becau se evidence is good that diabetes can be prevented (or its onset delayed). Patients with borderline elevations of low-density lipoprotein cholesterol concentrations and with high-normal glycosylated hemoglobin levels should b e considered for statin therapy, and patients with hypertension with high-n ormal glycosylated hemoglobin levels should be treated with angiotensin-con verting enzyme inhibitors as first-line agents. Studies to determine whethe r metformin is useful in this population are ongoing.