Treatment of patients with diabetes mellitus type 2 and coronary artery disease

Of all patients presenting with coronary, artery disease, 20-30% already have a diagnosis of diabetes mellitus type 2. Of the remaining patients, another 15-20% are found at presentation to have diabetes mellitus and 30% have glucose intolerance. Both conditions are major risk factors for the recurrence of coronary artery disease and mortality. The treatment of patients with diabetes mellitus type 2 always includes improvement in lifestyle, adequate blood-glucose control, cholesterol-lowering therapy and blood-pressure control. Furthermore, if one or more other traditional cardiovascular risk factors are present, or if the patient is over 40 years of age, acetylsalicylic acid must be added. Finally, with a prior history of coronary-artery disease, patients must be given an angiotensin converting enzyme (ACE) inhibitor. During percutaneous coronary interventions, patients with diabetes mellitus type 2 are preferably treated with a drug-eluting stent in combination with clopidogrel, and in case of an acute coronary syndrome, glycoprotein (GP) IIb/IIIa receptor antagonists are added to the standard treatment.