Type 2 diabetes, in the heart of the metabolic syndrome: plea for a global approach

peer reviewedType 2 diabetes is frequently associated with other comorbidities among which abdominal obesity, arterial hypertension, dyslipidaemia and a prothrombotic state. All these cardiovascular risk factors belong to the so-called metabolic syndrome. The appropriate management of a patient with type 2 diabetes requires a global approach targeting each risk factor in order to reduce cardiovascular morbidity and mortality. Microalbuminuria is correlated with markers of the metabolic syndrome in diabetic patients as shown by the DANA survey performed among general practitioners from the areas of Liege and Antwerp and, in this type of patients, is considered as a prognostic factor of cardiovascular complications. The OCAPI study, performed among Belgian internists and diabetologists, demonstrated that two thirds of diabetic patients have a metabolic syndrome and that the objectives are far from being reached in clinical practice, especially as far as lipid and arterial pressure control is concerned. Interestingly, the Danish STENO-2 study demonstrated that an intensive multi-risk approach reduces the incidence of both micro- and macroangiopathic complications by more than 50%. This challenge represents a major public health issue considering the high and increasing prevalence of type 2 diabetes and the major burden associated to this disease