2013 ESC Guidelines on Diabetes, Pre-diabetes and Cardiovascular Diseases

BySteven Lome, MD

Year released: 2013

Society: European Society of Cardiology (ESC)

Collaboration: European Association for the Study of Diabetes (EASD)

Summary

Approximately 360 million people had diabetes in 2011. This number, according to the writing committee, is estimated to increase to 552 million by 2030, and it is thought that about half of those individuals will be unaware of their diagnosis.

Additionally, it is estimated that another 300 million individuals had features indicating future risk for developing type 2 diabetes, including fasting hyperglycemia, impaired glucose tolerance (IGT), gestational diabetes and euglycemic insulin resistance (IR).

Most new cases of type 2 diabetes, according to the committee, occur in the context of Westernized lifestyles, high-fat diets and decreased exercise, leading to increasing levels of obesity, IR, compensatory hyperinsulinemia and, ultimately, beta-cell failure and type 2 diabetes.

More than half the mortality and a vast amount of morbidity in people with diabetes is related to cardiovascular disease (CVD). This development, the committee wrote, has encouraged organizations such as the ESC and EASD to work together.

The goal of these guidelines, according to the committee, is to provide information on the current state of the art in how to prevent and manage the diverse problems associated with the effects of diabetes on the heart and vasculature in a holistic manner. The guidelines are intended to be an educational tool and help describe the latest management approaches and create an algorithm for achieving the best care for patients in an individualized setting.

The committee notes that these guidelines are written for the management of the combination of CVD (or risk for CVD) and diabetes, but not as a separate guideline for each condition.

Diagnosis of disorders of glucose metabolism

The panel placed recommendations into various classes to help identify the strength of each recommendation. Anything labeled as class I was considered strong, recommended and should be performed or administered. Anything labeled class III had no benefit or the risk outweighs the benefit.

A class I recommendation suggests that the diagnosis of diabetes should be based on HbA1c and fasting plasma glucose (FPG) combined or an oral glucose tolerance (OGTT) test if still in doubt.

Appropriate lifestyle counseling is strongly recommended for people at high risk for type 2 diabetes to reduce their risk for developing diabetes.

An additional class I recommendation indicates that screening for potential type 2 diabetes in people with CVD should be initiated with HbA1c and FPG and that an OGTT is added if HbA1c and FPG are inconclusive.

Cardiovascular risk assessment in diabetes

The strongest recommendation the committee made is that it is important to estimate the urinary albumin excretion rate when performing risk stratification in patients with diabetes.

However, the remaining recommendations were either considered weak or not recommended. The committee did not recommended physicians to assess the risk for CVD in patients with diabetes based on risk scores developed for the general population.