CHAPTER 14 Diabetes Mellitus and Metabolic Syndrome
This chapter reviews an evidence-based approach to diagnosis and treatment of diabetes mellitus and metabolic syndrome according to recent scientific evidence and recommendations of major international guidelines. The pathophysiology and clinical management of atherosclerotic complications are considered as a continuum rather than separate issues, merging basic and clinical sciences into a ‘bench-to-bedside’ approach.It is estimated that diabetes affects about 246 million people world-wide, with an expected 55% increase to 380 million in 2025. Approximately 50% of persons above the age of 60 years will meet current diagnostic criteria for metabolic syndrome in the near future. Hyperglycaemia, insulin resistance, and the consequent cellular shift to an increased oxidative stress carry a high risk for development of comorbidities and cardiovascular risk factors, mainly hypertension, lipid disorders, a proinflammatory state, and activation of coagulation and thrombosis. As a consequence, the incidence of and mortality from all forms of cardiovascular disease are two- to eightfold higher in persons with diabetes, and coronary artery disease accounts for 75% of all deaths in such individuals. The impressive burden of the disease supports the employment of comprehensive risk stratification systems to identify patients who, besides glycaemic control, will benefit from a multifactorial management with statins, aspirin, renin–angiotensin system antagonists, and coronary interventions supplemented by drug-eluting stents and antithrombotic agents to prevent cardiovascular events.
Chapter 28)
