Rationale:

• The postoperative assessment provides an opportunity for the physician to provide risk factor reduction management to prevent progression of cardiac and diabetic complications.

Evidence:

• In the Steno-2 study, 160 patients were randomly assigned to usual care vs. intensive, targeted, multifactorial intervention on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. Intensive risk factor reduction targeted glycemic control, BP control, dyslipidemia, microalbuminuria, and secondary prevention of cardiovascular disease with aspirin. Patients assigned to intensive therapy had a significantly lower risk of cardiovascular disease (hazard ratio, 0.42) (64).
• Numerous randomized, controlled trials of drug management of lipid risk factors in diabetic patients have shown a favorable effect on coronary and other atherosclerotic endpoints (65; 66; 67).
• Consensus guidelines recommend screening and treatment of lipid disorders for both primary and secondary prevention of CAD (68). Specifically, supported by the intervention trials in diabetic populations, the American Diabetes Association recommends lipid-modifying therapy as part of the treatment regimen, the intensity of which varies depending on patient age, the presence or absence of cardiovascular disease, and the presence or absence of risk factors (other than diabetes) for cardiovascular disease (4).
• A post-test survey showed that simple postdischarge educational classes improved knowledge of CAD and health-promoting behaviors (69).
• Studies on the prevention of foot ulceration using education in diabetes suggest that there may be a short-term benefit to education (70).

Comments:

• The American Diabetes Association recommends statin therapy to achieve an LDL cholesterol target <100 mg/dL and a BP target <130/80 mm Hg, ACE inhibitor or angiotensin receptor blocker therapy to achieve a BP target <130/80 mm Hg and reduce microalbuminuria, and aspirin therapy if there are no contraindications. They also recommend yearly dilated eye exam and nightly foot exam.
• Starting medications that are considered the standard of care in patients with diabetes prevents vascular complications.