Practice Guidelines

Preventing CVD in Adults with Type 2 Diabetes Mellitus: An Update from the AHA and ADA


Am Fam Physician. 2016 Feb 1;93(3):232-233.

Key Points for Practice

• For most persons with diabetes, A1C should be at 7% or lower to decrease the occurrence of microvascular disease.

• An angiotensin-converting enzyme inhibitor or angiotensin receptor blocker should be used to treat hypertension.

• Patients should receive a high-intensity statin if they have at least a 7.5% risk of atherosclerotic CVD.

• A dosage of 75 to 162 mg per day of aspirin is an option in persons with a 10-year risk of CVD of 10%.

From the AFP Editors

Cardiovascular disease (CVD) is the leading cause of death in persons with diabetes mellitus. In 1999 and again in 2007, the American Heart Association (AHA) and American Diabetes Association (ADA) joined together to release statements on preventing CVD in persons with diabetes. New data have emerged since the publication of these statements; therefore, an updated guideline has been released. The ADA now states that an A1C of ≥ 6.5% or previous criteria for fasting glucose (≥ 126 mg per dL [7.0 mmol per L]) or two-hour glucose (≥ 200 mg per dL [11.1 mmol per L]) may be used for diagnosing diabetes.



Persons who are overweight or obese should reduce their energy intake, and should receive counseling that certain changes in lifestyle can result in a maintainable weight loss (3% to 5%), which has a variety of health benefits. If weight loss cannot be achieved with these changes alone, pharmacologic therapy and surgery, which have been shown to typically result in more weight loss compared with lifestyle changes or placebo, may also be options.

Pharmacologic Therapy. Medications to assist with weight loss are appropriate for persons with a body mass index of 25 to 30 kg per m2 and comorbidities, or persons with a body mass index greater than 30 kg per m2, regardless of the presence of comorbidities. Multiple medications approved by the U.S. Food and Drug Administration for managing obesity in the long term (about one year; i.e., orlistat [Xenical], lorcaserin [Belviq], and extended-release topiramate/phentermine [Qsymia]) and short term (less than three months; i.e., phentermine [Adipex], diethylpropion [Radtue], benzphetamine [Didrex], and phendimetrazine

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at


Copyright © 2016 by the American Academy of Family Physicians.
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