[Should the diabetic coronary patient benefit from specific management: the viewpoint of the diabetologist].

Type 2 diabetes is a strong independent risk factor for coronary heart disease, which is responsible for at least 50% of deaths in this disease. After acute myocardial infarction, mortality in diabetic patients is twice that observed in non-diabetic patients. This high mortality is partly related to poor care. Thrombolysis, cardioselective beta-blockers and angiotensin-converting enzyme inhibitors are more effective in reducing cardiovascular morbidity and mortality in diabetic than non-diabetic patients, and strict glycaemic control can decrease mortality significantly. Secondary prevention by pharmacological and non-pharmacological means is also very effective in diabetic patients with coronary heart disease, although often poorly used by patients and physicians. Diabetic patients with stable angina or silent myocardial ischaemia should be diagnosed early in the course of the disease, if necessary by non-invasive investigation. The diagnosis of coronary heart disease in diabetic patients may lead to modifications in treatment goals and modalities. As the prevalence of diabetic patients with coronary heart disease is increasing, it might be feasible to establish special cardiodiabetic units in which they could benefit from close daily cooperation between diabetologists and cardiologists.