In September 1998, the results of the longest and largest study of people with type 2 diabetes were announced. The goal of the United Kingdom Prospective Diabetes Study was to determine whether people with type 2 diabetes benefit from intensive glucose and blood pressure control. Outcome data demonstrated that for people with type 2 diabetes, aggressive control of blood glucose and blood pressure reduced the risk of heart failure by 56 percent, stroke by 44 percent, and death from diabetes by 32 percent. 9 Strategies to achieve this goal include exercise, restriction of salt and alcohol, weight loss, smoking cessation, and medications. The ADA recommends ACE inhibitors as the first agent of choice to lower blood pressure given its renal protective effect and neutral effect on glucose and lipids.
ACE inhibitors decrease peripheral arterial resistance and increase cardiac output.
While loop and thiazide diuretics are often first- line therapy for blood pressure, they can worsen glucose and lipid levels at high doses. The choice of agent is based on the overall patient profile and physician assessment. If lipid goals are not achievable through exercise, medical nutrition therapy, glucose control, and weight loss, then pharmacologic intervention is indicated. Statins reduce the production or increase the breakdown of LDLs. Resins work by increasing the clearance of cholesterol-rich lipoproteins from the plasma.