In spite of recent advances in therapy, this chronic condition continues as the leading cause of adult blindness, end-stage renal disease and nontraumatic amputations. Glycemic control is the first step in minimizing diabetic target organ damage. One of insulin s many actions is as a tissue growth factor, enhancing smooth muscle proliferation and possibly contributing to the development of atherosclerosis. Injectable insulin tends to keep levels consistently high.
Sulfonylureas enhance insulin release.
When working with the patient to achieve the recommended glycemic goals, enhanced insulin sensitivity and reduced circulating insulin levels through the use of metformin or a glitazone should be considered, either alone or in conjunction with other agents. Most diabetics require 2-3 or more medications in addition to life style modification to achieve this degree of blood pressure reduction. Enhanced glycemic control as well as aggressive management of dyslipidemia can reduce atherosclerotic risk. The most common pattern of dyslipidemia in this population is elevated triglycerides and decreased HDL, while LDL elevation is likely no more common than in the general population. However, when compared to the nondiabetics with similar LDL measurement, type 2 diabetics usually have a predominance of smaller, denser LDL particles that are likely highly atherogenic.