Primary and secondary prevention in diabetic patients: are we not aggressive enough?

Epidemiology In 1985, 30 million patients had a diagnosis of diabetes mellitus around the world; in 2014, the number increased to 382 million. It is estimated that in 2035, 592 million patients will suffer from diabetes mellitus; approximately 1/10 of the world population. Healthcare cost per year of any patient with diabetes mellitus is approximately twice the cost of the same patient without diabetes mellitus. The higher prevalence of diabetes mellitus is largely due to an increase of type 2 diabetes mellitus (DM2), even though diabetes mellitus type 1 (DM1) is also increasing. In Italy, ISTAT data documented a prevalence of diabetes mellitus, in a general population, of 5.5% with significant differences between the north and the south of the country (4.7 and 6.5%, respectively) and a progressive increase with age (20.3% over 75 years). Higher prevalence is associated with economic strains, lower level of education, and obesity, which are more common in the south of the country. The injuries deriving from diabetes mellitus to the vascular system (small-vessel and large-vessel disease) account for the very high cardiovascular risk associated with this condition. The Framingham Heart Study revealed a significant increase in mortality among diabetic patients when compared with nondiabetic patients, with a yearly rate of cardiovascular mortality raising from 1.3 to 5.1/1000 for women and from 2.4 to 6.8/1000 for men. The Diabetes Epidemiology: Collaborative analysis of