Management of hyperglycemia in diabetics with cardiovascular disease

Diabetes mellitus is a syndrome characterized by hyperglycemia and dyslipidemia; and is associated with various systemic complications including acute metabolic emergencies and chronic complications, which includes microvascular and macrovascular manifestations. Coronary artery diseases are the major causes of morbidity and mortality. Various studies have convincingly demonstrated that managing hyperglycemia adequately is important for controlling diabetic complications, but macrovascular complications have not shown as significant reduction as have microvascular diseases. The cardiac safety of various anti-diabetic agents available to us also vary, which suggests that both euglycemia per se, as well the agent used to achieve it, are important considerations for cardiovascular safety. The Food and Drugs Administration of the United States of America has now stipulated that all anti-diabetic medications must undergo cardio-vascular outcome trials to prove cardiac safety before they are approved for use. Most currently available anti-diabetics are neutral on the heart, and may be continued safely in patients with chronic stable coronary artery disease (CAD). However, recent data from cardio-vascular outcome trials involving SGLT2-inhibitors and GLP1R-analogs demonstrate impressive cardiac safety data. Insulin still remains the agent of choice during recent acute coronary events and critical-care management. Keywords: diabetes mellitus; hyperglycemia; macrovascular complication; coronary artery diseases; cardio-vascular outcome trials