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CardioDiabetes: Core Competencies for Cardiovascular Clinicians in a Rapidly Evolving Era of Type 2 Diabetes Management |
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| Authors: | G B John Mancini Alice Y Cheng Kim Connelly David Fitchett Ronald Goldenberg Shaun Goodman Lawrence A Leiter Eva Lonn Breay Paty Paul Poirier James Stone David Thompson Subodh Verma Vincent Woo Jean-Francois Yale |
| Institution: | 1. Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada;2. Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada;3. Division of Cardiology, Li Ka Shing Knowledge Institute and Keenan Centre for Biomedical Science, University of Toronto, Toronto, Ontario, Canada;4. Endocrinology and Metabolism, North York General Hospital and LMC Diabetes and Endocrinology, Toronto, Ontario, Canada;5. Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute and Keenan Centre for Biomedical Science, University of Toronto, Toronto, Ontario, Canada;6. Population Health Research Institute and Department of Medicine, McMaster University, Hamilton, Ontario, Canada;g. Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada;h. Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada;i. Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;j. Division of Surgery, Li Ka Shing Knowledge Institute and Keenan Centre for Biomedical Science, University of Toronto, Toronto, Ontario, Canada;k. Section of Endocrinology and Metabolism, John Buhler Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada;l. Division of Endocrinology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada |
| Abstract: | A sea change in the management of diabetes is occurring with the publication of clinical trials showing unequivocal cardiovascular (CV) protection through the use of certain antihyperglycemic agents. This change is similar to the change that occurred when lipid lowering with statins was first shown to have CV benefits, an event necessitating changes in training and the proactive treatment of lipids by CV specialists. As was the case then, many CV specialists currently feel poorly equipped to address diabetes with this new information even though diabetes is common in CV practice. The purpose of this overview is to provide an updated, comprehensive, and evidence-based CV protection plan for patients with type 2 diabetes, intended specifically for cardiologists and vascular medicine specialists. We attempt to elucidate a set of “CardioDiabetes” core competencies by merging the CV-relevant elements of the Diabetes Canada 2018 guidelines within a framework of comprehensive vascular protection as supported by other CV guidelines. We review the rationale for measuring hemoglobin A1C, understanding its use for establishing a diagnosis and for monitoring treatment. We also provide a brief review of the medications most important for a CV specialist to know. We provide useful memory aids and a succinct set of reminders and tips (“ABCDEFR’S”) that can serve as a comprehensive checklist in the clinic and help to motivate trainees and clinicians to consult the original guideline source documents to enrich their knowledge and improve treatment in this rapidly changing arena. |
| Keywords: | Corresponding author: Dr G B John Mancini Rm 489 828 W 10th Ave Vancouver British Columbia V5Z 1M9 Canada Tel : +1-604-875-4475 fax: +1-604-875-4471 |
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