Comments on the 2023 ESC guidelines on cardiovascular disease in patients with diabetes

Abstract

The new guidelines of the European Society of Cardiology (ESC) 2023 for the management of patients with cardiovascular (CV) disease (CVD) and diabetes incorporate a central figure that focuses on the presentation of a patient with diabetes and CVD: first case: a patient with CVD that includes atherosclerotic cardiovascular disease (ASCVD), atrial fibrillation (AF) and heart failure (HF), in whom diabetes screening must be performed; second case, a patient with diabetes in whom CVD or chronic kidney disease (CKD) must be ruled out. In the first case, there are no changes for the diagnosis of diabetes using the already known diagnostic criteria1: a) fasting plasma glucose ≥ 126mg/dL; b) glycated hemoglobin (HbA1c) ≥ 6.5%; c) plasma glucose 2hours after an oral glucose overload test (75g) ≥ 200mg/dL; and d) plasma glucose ≥ 200mg/dL in patients with classic symptoms of hyperglycemia or a hyperglycemic crisis. In the second case, CVD screening is recommended based on the patient's symptoms and electrocardiogram (ECG). The document does not introduce peptides in this screening, or imaging tests, or detection of ischemia in asymptomatic patients with diabetes.