Future Goals

Given the unique characteristics and tremendous impact of cardiovascular and peripheral vascular disease in the diabetic population, large prospective studies specifically examining pathophysiology, screening, and efficacy of therapy in this population are warranted. The BARI 2D trial will likely answer whether medical therapy alone, percutaneous coronary intervention, or coronary artery bypass grafting in the setting of strict blood glucose control is the optimal treatment for individuals with type 2 diabetes mellitus with stable CAD. In addition, trials examining the role of HMG-CoA reductase inhibitors, as well as gemfibrozil and other fibrate drugs, specifically in the diabetic population have been proposed or are ongoing. Studies such as these should provide further insight to guide prevention strategies in this high-risk population.

In the meantime, it is important to recognize both the considerable potential for, and serious adverse effects of cardiovascular and peripheral vascular disease in the diabetic population. There is justification to have a lower threshold to screen for cardiovascular disease and to aggressively modify other cardiovascular risk factors, when faced with the challenges of managing the diabetic patient.

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