Treating diabetes: cardiovascular benefits of antidiabetes drugs.

Type 2 diabetes is a metabolic disorder that, if untreated, can result in macrovascular and microvascular complications. Lowering blood glucose levels primarily reduces microvascular risk; other treatment strategies are necessary to lower the risk for macrovascular disease. Because most patients with diabetes die of macrovascular disease, it is vitally important that patients with diabetes receive aggressive therapies to lessen this risk. It has been found that the risk for macrovascular complications begins even earlier than the risk for microvascular complications. Therefore, patients with insulin resistance (now called prediabetes) should be identified and treated to lower their risk of cardiovascular disease and reduce their risk for progression to diabetes. Two cases are reviewed--a patient with prediabetes and the metabolic syndrome, and a second patient with type 2 diabetes and advanced cardiovascular disease. A review of potential cardiovascular therapies is included.