• Heart disease is the leading cause of diabetes-related deaths. Adults with diabetes have heart disease death rates about 2 to 4 times as high as that of adults without diabetes.
• Either Type 1 or Type 2 diabetes increases your risk of cardiovascular disease (CVD). Men with diabetes have a greater risk of CVD than women. After menopause, the risk increases for women with diabetes.

Type 2 diabetes is associated with a 2 to 4-fold excess risk of coronary heart disease (CHD). Although the degree of glycemia in diabetic patients is strongly related to the risk of microvascular complications, the relation of glycemia to macrovascular disease in Type 2 diabetes is less certain. The manifestations of diabetic macrovascular disease are coronary heart disease (CHD), cerebrovascular disease (CVD), and peripheral vascular disease (PVD). Macrovascular disease seen in diabetic patients is similar to non-diabetic patients, with the major difference is that it occurs at an earlier age and with increased frequency. Additionally, diabetic patients may have atypical presentations of coronary artery disease (e.g. congestive heart failure).

Risk Factors for Microvascular Disease:
Major co-morbidity includes, but is not limited to, any or several of the following conditions: cardiovascular disease, chronic obstructive pulmonary disease, chronic liver disease, stroke, malignancy, and etc.

• Mild microvascular disease is defined by early background retinopathy, and/or microalbuminuria and/or mild neuropathy.
• Moderate microvascular disease is defined by pre-proliferative retinopathy, macroalbuminuria) and/or demonstrable peripheral neuropathy (sensory loss).
• Advanced microvascular disease is defined by severe non-proliferative retinopathy and/or renal insufficiency (serum creatinine > 2.0 mg/dl) and/or insensate extremities or severe autonomic neuropathy (gastroparesis, impaired sweating, orthostatic hypotension, etc.).

Major causes of death among diabetic patients:

• Ischemic heart disease                            40%
• Other heart disease                                 15%
• Complications of acute diabetes              13%
• Cancer                                                   13%
• Stroke                                                    10%
• Pneumonia/influenza                                04%
• All other causes                                      05%