Abstract: . . .  several key points about type 2 diabetes : • it is a progressive disease. Even with initial intensive treatment with insulin or a sulphonylurea most patients require a combination of oral antidiabetic agents and/or insulin to optimise glycaemic control • improved glycaemic control (HbA1c 7.0 per cent in the intensive group versus 7.9 per cent in the conventional group) was associated with a lower rate of appearance and progression of microvascular complications • intensive treatment with sulphonylureas or insulin carries a risk of hypoglycaemia and weight gain (mean 2.9 kg) • the first line use of metformin treatment in overweight patients reduced diabetes related end points and death without causing significant weight gain. Furthermore, there was a significant reduction in cardiovascular events. However, this effect was not seen when metf . . .
. . .  cardiovascular disease is two to four times higher in patients with type 2 diabetes than in non-diabetics. 47 The excess mortality from cardiovascular disease is, however, most pronounced in young people with type 1 diabetes . 48 The prevalence rates of cardiovascular disease in the diabetic population show some variation between populations, but in general, the prevalence of diabetes increases the underlying cardiovascular disease in all populations. Even in countries such as Japan, with a low incidence of CHD in the diabetic population, the risk of developing CHD is significantly higher than in the background population. 49 Pima Indians have the highest reported prevalence of type 2 diabetes worldwide, but a relatively low frequency of CHD. 49 This suggests that cultural, ethnic and genetic factors are important in determining the risk of CHD developing in individuals with type 2 diabetes . The key features of cardiovascular disease in individuals with diabetes can be summarised as follows: • increased risk of cardiovascular disease • loss of the protective cardiovascular effects normally conferred on premenopausal females 50 • a younger age of onset of cardiovascular disease 51 • worsened prognosis in terms of mortality from cardiovascular disease. British Medical Association Diabetes . . .
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