Recommended Care
• Cardiovascular risk factors that should be assessed in all patients at diagnosis and annually including
▫ Dyslipidemia
▫ Hypertension
▫ Smoking status
▫ Family history of premature coronary disease
▫ Presence of albuminuria
▫ Body mass index (BMI) ≥25
▫ Presence of hyperuricemia
• Current or previous CVD events, age, body weight, BP and pulse, of patients should be recorded during their first and subsequent visits
• UKPDS risk engine and QRISK3 are simple and effective tools for identifying and predicting CVD risks in patients with T2DM and should be recommended for identifying high risk individuals*
• Patients with diabetes and CVD risk should follow the ABC treatment goals**
▫ A (HbA1c): <7%
▫ B (BP): <130/80 mmHg
▫ C (Cholesterol -LDL): <100 mg/dL
• All patients should be managed with lifestyle intervention including physical exercise and medical nutrition therapy
• Yoga has shown efficacy in improving the dyslipidemia state and lower BMI, in selected patients with T2DM.
• In high risk patients, low dose aspirin therapy should be administered along with lifestyle intervention
• Statins should be added to lifestyle intervention in all patients with CVD risk, if not contraindicated. The intensity can be modified or titrated according to patient’s CVD risk, age, side-effects, tolerability, LDL-C levels etc.
• Glycemic control with glucose lowering drugs that are proven to be CV safe and beneficial should be recommended to reduce CVD risk and complications in patients with T2DM. SGLT2 inhibitors and GLP-1 receptor agonists are approved by various regulatory authorities for CV risk reductions, apart from their glucose lowering ability.
• Weight control should be an important consideration, while choosing glucose lowering therapy in overweight/obese persons
• Pharmacological antihypertensive therapy with subsequent titration in addition to lifestyle therapy should be initiated in patients with confirmed office-based BP of >140/90 mmHg
• Pharmacological therapy for patients with diabetes and hypertension should comprise a regimen that includes ACE inhibitor/ARB, thiazide diuretics, calcium channel blockers, and selective β blockers. If one class is not tolerated, it should be substituted with other class; however, FDCs of different drug classes may be preferred in patients with diabetes to reduce CVD risks and complications
• ACE inhibitors are the drug of choice for diabetes, if not contraindicated; and ARBs may be used if ACE inhibitors are not tolerated
• Other medications for dyslipidemia (fibrates, ezetimibe, concentrated omega-3 fatty acids, PCSK9 inhibitors) can be considered in patients failing to reach targets with conventional lipid lowering medications

*The treatment target goals should be individualized according to age, risk and comorbidity. **Risk factor: Low-density lipoprotein (LDL)-cholesterol ≥100 mg/dL (2.6 mmol/L), high blood pressure (> 140/90 mm Hg), smoking, overweight/obese, lack of physical activity