18
Standards of Medical Care
Smoking Cessation
Î Advise all patients not to smoke or use tobacco products. (A)
Î Include smoking cessation counseling and other forms of treatment as
a routine component of diabetes care. (B)
Cardiovascular Disease (CVD)
Screening
Î In asymptomatic patients, routine screening for coronary artery
disease is NOT recommended because it does not improve outcomes
as long as CVD risk factors are treated. (A)
Treatment
Î In patients with known CVD, consider ACE inhibitor therapy (C) and
use aspirin and statin therapy (A) (if not contraindicated) to reduce the
risk of CV events.
Î In patients with a prior myocardial infarction, continue β-blockers for
at least 2 years after the event. (B)
Î Avoid thiazolidinedione (TZD) treatment in patients with symptomatic
heart failure. (C)
Î Metformin may be used in patients with stable congestive heart failure
(CHF) if renal function is normal but should be avoided in unstable or
hospitalized patients with CHF. (B)
Nephropathy
Î Optimize blood pressure and glucose control to reduce the risk or slow
the progression of nephropathy. (A)
Screening
Î Perform an annual test to quantitate urine albumin excretion in
patients with type 1 diabetes for ≥5 years and in all patients with
type 2 diabetes starting at diagnosis. (B)
Treatment
Î An ACE inhibitor or ARB for the primary prevention of diabetic kidney
disease is NOT recommended in diabetic patients with normal blood
pressure and albumin excretion <30 mg/24 h. (A)
Î Either ACE inhibitors or ARBs (but not both in combination) are
recommended for the treatment of the nonpregnant patient with
modestly elevated (30-299 mg/24 h) (C) or higher levels
(>300 mg/24 h) of urinary albumin excretion. (A)
