Perspective:

The following are 10 points to remember about these European Society of Cardiology (ESC) Guidelines:

1. It is recommended that screening for potential type 2 diabetes mellitus (T2DM) in people with cardiovascular disease (CVD) is initiated with glycated hemoglobin (HbA_1c) and fasting plasma glucose (FPG), and that an oral glucose tolerance test (OGTT) is added if HbA_1c and FPG are inconclusive.

2. It is recommended that in the prevention of T2DM and control of DM, total fat intake should be <35%, saturated fat <10%, and monounsaturated fatty acids >10% of total energy. Moderate to vigorous physical activity of ≥150 minutes/week is recommended for the prevention and control of T2DM, and prevention of CVD in DM.

3. An HbA_1c target of <7.0% (<53 mmol/mol) to reduce microvascular disease is a generally accepted level. It is recommended that glucose lowering is instituted in an individualized manner taking duration of DM, co-morbidities, and age into account. Metformin should be considered as first-line therapy in subjects with T2DM following evaluation of renal function.

4. Glycemic targets for elderly people with long-standing or more complicated disease should be less ambitious than for younger, healthier individuals. If lower targets cannot be achieved with simple interventions, an HbA_1c of <7.5–8.0% (<58–64 mmol/mol) may be acceptable, transitioning upward as age increases and capacity for self-care, cognitive, psychological, and economic status and support systems decline.

5. It is recommended that a patient with hypertension and DM is treated in an individualized manner, targeting a blood pressure of <140/85 mm Hg. Simultaneous administration of two renin-angiotensin-aldosterone system (RAAS) blockers should be avoided in patients with DM.

6. Antiplatelet therapy with aspirin in DM patients at low CVD risk is not recommended.

7. Statin therapy is indicated in patients with DM and coronary artery disease (CAD) to reduce the risk for CV events. Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers are also indicated in patients with DM and CAD to reduce the risk for CV events.

8. Optimal medical treatment should be considered as preferred treatment in patients with stable CAD and DM unless there are large areas of ischemia or significant left main or proximal left anterior descending artery stenosis. Coronary artery bypass grafting is recommended in patients with DM and multivessel or complex (SYNTAX score >22) CAD to improve survival free from major CV events.

9. Thiazolidinediones should not be used in patients with heart failure and T2DM since water retention may worsen or provoke heart failure.

10. Patient-centered care is recommended to facilitate shared control and decision making within the context of patient priorities and goals. Furthermore, patient-centered cognitive behavioral strategies are recommended to help patients achieve lifestyle changes and practice self-management.