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Cardio-diabetology or diabeto-cardiology

ESC Congress Report

  • Oral glucose tolerance testing should be performed when diabetes is suspected in heart disease patient.
  • Lifestyle modifications precede drug treatment.
  • PCI good choice for diabetics with one- or two-vessel disease, CABG better for triple vessel disease.


View the Slides from this session in ESC Congress 365

The overlapping  areas of diabetology, cardiology and nephrology were discussed based on case presentations. Prof. K. Kotseva (London, GB) presented a 58y/o male patient with all major risk factors but so far unknown diabetes. Despite a normal HbA1c level, his oral glucose tolerance test (OGTT) was in the diabetic range, which is common in the early stage of diabetes. In this case, a comprehensive lifestyle intervention multifactorial treatment was successful in a compliant patient: weight was reduced, physical activity increased and a statin (that conformed to guidelines) was started. But not all patients are able to comply in such a perfect way.

Prof. Marre (Paris, FR) emphasized that the guidelines require an OGTT if the diagnosis is in doubt. There was agreement among the discussants that a comprehensive lifestyle approach should be started before anti-diabetic medications. With the current management options the traditional UKPDS-Riskscore (from the 80s of the last century) overestimates the risk by 200% (Prof. Standl). Symptomatic patients with coronary disease are revascularized depending on the extent of ischemic area and extent of vessel disease. If in single and double vessel disease the anatomy is suitable PCI with drug-eluting stents can be performed. In patients with 3-vessel disease or left main stem stenosis bypass surgery is the preferred option because of improved survival.
Renal function is particularly endangered in diabetics and repeated measurements of albuminuria should be a routine to evaluate renal function. Metformine should be used under close monitoring if the glomerular filtration rate is less than 50ml. If there are doubts about the treatment, a nephrologist  should be consulted.
Because the diabetic coronary patient is particularly vulnerable with respect to his vessels, his blood and his myocardium a close cooperation between the cardiologist and the diabetologist is in the best interest of the patient.

References


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SessionTitle:

Cardio-diabetology or diabeto-cardiology

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.