New ESC Guidelines Focus on Diabetes Management

The European Society of Cardiology (ESC) has released new guidelines on diabetes, pre-diabetes and cardiovascular disease. Key recommendations include glycated haemoglobin (HbA1c) as a screening strategy to diagnose diabetes, and recommendations for prevention, blood pressure and glucose levels, antiplatelet therapy, statin therapy, and more. Developed in collaboration with the European Association for the Study of Diabetes, the 2013 guidelines are an update to the 2007 document, and were published Aug. 30 in the European Heart Journal and presented at the ESC Congress 2013 in Amsterdam.

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According to the document, “screening an HbA1c >6.5 percent is diagnostic of diabetes,” but if the screening is between 6.0 – 6.5 percent, “fasting plasma glucose needs to be measured to establish a diagnosis.” Further, if HbA1c is not elevated, patients with cardiovascular disease should receive an oral glucose tolerance test.

Of note, recommendations on revascularization have been updated, and suggest “medical therapy before interventions in patients with stable coronary artery disease and no complex coronary lesions.” Also new is the recommendation that “patients with several or complex coronary artery stenoses should be offered bypass surgery before percutaneous coronary dilatation.”

The guidelines recommend individualized targets for blood pressure and glucose, with <140/85mmHg as the general blood pressure target for diabetics, but note that control should be stricter in patients at risk of stroke. However, simultaneous administration of two renin-angiotensin-aldosterone system blockers should be avoided in patients with diabetes.

Other changes include the prioritization of weight stabilization and it is recommended that in the prevention and control of diabetes, total fat intake should be <35 percent, saturated fat <10 percent, and monosaturated fatty acids >10 percent of total energy. Further, moderate to vigorous physical activity of ≥150 minutes/week is recommended for prevention and control of diabetes and prevention of cardiovascular disease in diabetes patients.

Antiplatelet therapy with aspirin in patients with diabetes at a low risk of cardiovascular disease is not recommended. Meanwhile, statin therapy is indicated in patients with diabetes and coronary artery disease to reduce the risk for cardiovascular events.

The document also includes information on the importance of patient-centered care to encourage shared decision making. “When [a patient-centered care] approach is used by a multidisciplinary team with skills in cognitive behavioral strategies there will be increased success in supporting patients in achieving lifestyle changes and effectively self-managing their conditions,” the authors note.

“Diabetes is a complex disease and it is very important that cognitive behavioral strategies are built into the treatment strategy so that the patient is empowered to take care of themselves to a large extent,” adds Professor Peter J. Grant, co-chair of the task force.

Keywords: Cooperative Behavior, Coronary Artery Disease, Life Style, Cognition, Stroke, Decision Making, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Fatty Acids, Renin-Angiotensin System, Dilatation, Blood Pressure, Patient-Centered Care, Glucose, Glycated Hemoglobin A, Glucose Tolerance Test, Coronary Stenosis, Motor Activity, Diabetes Mellitus, Fasting

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