Key Points

• Normalization of glucose control as far as can be accomplished safely has become the objective of all diabetic therapy.

• Physical therapies should promote blood flow into the foot and nerve function and stimulate the patient's psyche.

• Examination of the retina is critical to determine changes requiring immediate attention.

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are effective in reducing and reversing microalbuminuria and slowing the onset of diabetic nephropathy, independent of blood pressure (BP) control.

• Systolic BP should be less than 130 and diastolic less than 80 mm Hg, with HbA1c as close to normal as possible considering the risk of hypoglycemia.

• Coronary heart disease is so problematic among diabetic patients that the National Cholesterol Education Panel (NCEP), in recommending guidelines for the treatment of hypercholesterolemia, considers DM equal to prior evidence of coronary artery disease.

• The more risk factors and signs of diabetes (dyslipidemia, microalbuminuria, erectile dysfunction), the more aggressively the patient should be monitored for occult heart disease.

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