Prognosis

Cardiovascular disease (CVD) is the leading cause of death in people with diabetes.[11] People with diabetes have a 1.5- to 2-fold increased risk of myocardial infarction (MI) compared with people without diabetes. Coronary artery disease in people with diabetes is more severe, starts at an earlier age, and is more costly. Patients with type 1 diabetes are at higher risk of death after MI than patients without diabetes.[401]

Diabetes is an independent predictor of cardiovascular (CV) morbidity and mortality in people with heart failure.[402][403] The relative risk of CV-related death or heart failure-related hospitalisation is greater in people with preserved ejection fraction (diastolic heart failure) than with low ejection fraction. 

Multiple studies comparing coronary artery bypass graft versus percutaneous intervention with drug-eluting stents have shown that diabetes is an independent predictor of target lesion re-stenosis.[313][353] Drug-eluting stents appear to be superior to bare-metal stents in people with diabetes, with regard to major adverse cardiac events such as death, MI, or need for repeat revascularisation.[356][357][358][359][360]

While the benefits of optimising CVD risk factors are clear in patients with diabetes, in practice many patients are not achieving recommended targets.[404][405][406]​​​​ Data from the US Diabetes Collaborative Registry of 74,393 adults with diabetes demonstrate a prevalence of 74% with HbA1c <7%, 40% with blood pressure <130/80 mmHg, and 49% with low density lipoprotein-cholesterol <100 mg/dL (<70 mg/dL if with atherosclerotic CVD), but only 15% at target for all 3 factors.[407]​ Newer evidence-based therapies for diabetes proven to reduce CVD risk, including sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, remain highly underused.[4]

Use of this content is subject to our disclaimer