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Insulin therapy
A When an insulin treatment is started, it is recommended to maintain the metformin and /
or sulfonylureas therapy.
The need to continue with sulfonylurea or to reduce its dose due to hypoglycaemia risk
must be monitored.
A
D CPG
In patients with DM 2 who require insulinization the generalized use of insulin analogues
is not recommended. On the contrary, slow-acting insulin analogues should be used for
patients with an increasing risk to night hypoglycaemias. In patients with DM 2, when
intensive insulinization is required, fast-acting analogues have no advantages.
DCPC When choosing the initial insulin regimen, the preferences of the patient, the risk
of adverse effects (especially hypoglycaemia) and costs should be taken into consideration.
Screening and treatment of macrovascular complications
Cardiovascular risk and statin treatment
D
C
C
C
B
D
B
Localized evidence does not provide a recommendation favouring coronary heart disease
screening in the general asymptomatic diabetic population. More research is required for
selected groups at high risk.
Treating the general diabetic population with the same means as the population that has
suffered an myocardial infarction is not recommended.
Whenever necessary, a risk table should be used to calculate the coronary risk in diabetic
patients. The risk tables recommended are those from the REGICOR project.
In patients with diabetes for more than 15 years, especially in the case of women, it is
recommended to use an acetylsalicylic acid and statin treatment, due to its high cardiovascular
risk.
A statin treatment is recommended for diabetic patients with coronary risk ≥10% according
to the REGICOR table.
The evidence relating the effectiveness of aspirin in diabetic patients is controversial. The
use of aspirin treatment can be considered for diabetic patients with coronary risk ≥10%,
according to the REGICOR table, but risk benefict assessment is needed.
In type 2 diabetic patients with cardiovascular risk ≥10% in the REGICOR table and
for those where statins are contraindicated or are not tolerated, the use of fibrates can be
considered.
High blood pressure treatment
B/D
Patients with high blood pressure and DM 2 without nephropathy should receive treatment
to reduce their blood pressure until achieving an diastolic blood pressure (DBP)