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STATE-OF-THE-ART PAPER

Optimizing the diabetic formulary: beyond aspirin and insulin

^* Mid America Heart Institute, Saint Luke’s Hospital, Kansas City, Missouri, USA

Manuscript received September 21, 2001; revised manuscript received March 12, 2002, accepted May 15, 2002.

^* Reprint requests and correspondence: Dr. Steven P. Marso, Assistant Professor, University of Missouri-Kansas City, Saint Luke’s Hospital, Mid America Heart Institute, 4401 Wornall, Kansas City, Missouri 64111, USA.
smarso{at}saint-lukes.org

Type 2 diabetes mellitus (DM) afflicts nearly 16 million persons in the U.S. Forty million people have impaired glucose tolerance and thus have a 10% annualized risk of developing type 2 DM. These prevalence rates are estimated to double within the next two decades. At-risk groups appear to be the elderly and minorities including African, Hispanic and Native Americans. While the epidemiologic underpinnings for this increase are not fully realized, there has been a parallel increase in societal obesity, sedentary lifestyle and a marked increase in type 2 DM among children. Although there have recently been noteworthy advances in the field of cardiovascular medicine, cardiovascular case fatalities remain the leading cause of death among diabetic patients. According to national health statistics, there continues to be a downward trend in cardiovascular mortality and morbidity. This observation has not been consistently noted among patients with DM and has led many to re-evaluate current treatment goals and pharmacologic regimens for the at-risk patients with type 2 DM. This shifting treatment paradigm for diabetic patients has led to a ratcheting down of targeted risk factor goals including low-density lipoprotein cholesterol, systolic and diastolic blood pressure, and serum glucose levels with a requisite increase in the number of pharmacologic agents being administered. This review focuses on the current adjunctive pharmacologic treatment regimen that is well suited for patients with type 2 DM.

Abbreviations and Acronyms   ACE   angiotensin-converting enzyme   ADA   American Diabetes Association   ARB   angiotensin receptor blocker   CHD   coronary heart disease   DM   diabetes mellitus   GP   glycoprotein   HDL   high-density lipoprotein   JNC   Joint National Committee   LDL   low-density lipoprotein   MI   myocardial infarction   NCEP   National Cholesterol Education Program   PCI   percutaneous coronary intervention   PPAR   peroxisome proliferation-activated receptor   PTCA   percutaneous transluminal coronary angioplasty   TZD   thiazolidinediones

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