These data are timely given that the European Association for the Study of Diabetes/American Diabetes Association (EASD/ADA) are currently revising their joint recommendations on hyperglycaemia management and because these guidelines are apparently going to highlight ‘the need to consider the patient's important comorbidities, particularly cardiovascular disease or high cardiovascular risk, in selecting glucose‐lowering therapy’ 17. Further, we wanted to investigate the scope for CVD reduction through known risk factor control by identifying the proportion of people having two, three, four or more risk factors for CVD in the Scottish population with Type 2 diabetes. Accordingly, we aimed to establish the current prevalence of established CVD in a typical contemporary population with Type 2 diabetes. For medical service planning and to understand current standards of care, it is important to quantify the unmet treatment needs of people with Type 2 diabetes, including the prevalence of established CVD and current drug treatment regimens in a broad and representative Type 2 diabetes population. Drug labels and clinical guidelines are being updated accordingly 9, 10, 11, 12, 13, 14, 15, 16, and it is hoped that the target of lowering HbA 1c in Type 2 diabetes and the major goal of lowering the cause of excess death will be increasingly achieved. These four drugs are canagliflozin (SGLT2i), empagliflozin (SGLT2i), liraglutide (GLP‐1RA) and semaglutide (GLP‐1RA). In four drugs from two anti‐diabetes drug classes, sodium glucose co‐transporter 2 inhibitors (SGLT2i) and glucagon‐like peptide 1 receptor agonists (GLP‐1RA), evidence of reduced risk of major CVD events has been demonstrated. For newer drugs, major cardiovascular outcome trials have been conducted in recent years 8. With regards to glycaemic control, evidence of vascular benefit has been demonstrated for metformin with respect to myocardial infarction and pioglitazone with respect to CVD by contrast heart failure is increased 5, 6, 7. Key aspects of the prevention of primary and secondary CVD in diabetes include smoking prevention, weight control, blood pressure reduction, cholesterol lowering and glycaemic control. Ongoing elevations in risk have been reported in recent data from Scotland 2, Sweden and the USA 3, 4. Cardiovascular disease (CVD) remains the leading cause of loss of life expectancy in Type 2 diabetes and rates remain elevated compared with those without diabetes. Total mortality rates are currently 40% higher in men and 50% higher in women with Type 2 diabetes mellitus compared with the background population 1.
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