Type 2 diabetes--the pharmacotherapy of glycaemic control and risk factor modification

Abstract

Background: Patients with diabetes have a high cardiovascular risk. In addition to achieving good glycaemic control, cardiovascular risk reduction is a vital component of management.

Objective: This article summarises the pharmacotherapy of diabetes--both the achievement and maintenance of good glycaemic control, and the attenuation of co-existent cardiovascular risk factors.

Discussion: Metformin is the first line hypoglycaemic agent when diet and exercise fail to achieve optimal glycaemia. The thiazolindinediones (glitazones) are effective new adjunctive oral hypoglycaemic agents that can be used in combination with either oral hypoglycaemics or insulin. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are beneficial in reducing long term complications of diabetes, especially in patients with microalbuminuria, hypertension, heart failure, previous acute myocardial infarction, and retinopathy. Statins are well established in both primary and secondary prevention in people with diabetes. Aspirin should be considered for primary prevention in patients with diabetes and increased cardiovascular risk.