Synopsis
Integrate vascular risk assessment and evidence-based prevention for adults with diabetes without reducing care to a single score or medicine.
- Separate primary prevention from established cardiovascular disease because risk scoring, antithrombotic treatment and lipid intensity are not interchangeable between those settings.
- Address smoking, blood pressure, atherogenic lipids, albuminuria, glycaemia, weight, physical activity and medicines adherence as one longitudinal plan rather than isolated annual-review boxes.
- Use the current NICE risk-assessment method where it applies, but do not use a calculated score to downgrade people who already have cardiovascular disease or another high-risk condition.
Key red flags
Exertional breathlessness, unexplained falls, epigastric pressure or reduced exercise tolerance may be an anginal equivalent, especially with autonomic neuropathy; investigate symptoms clinically rather than arranging routine screening of every asymptomatic adult.
Investigation priorities
Define secondary-prevention disease, current symptoms and modifiable exposures before calculating risk.
Management branches
An adult with diabetes attends cardiovascular or annual long-term-condition review.
- Search the record and history for coronary, cerebrovascular and peripheral arterial disease, heart failure, chronic kidney disease, albuminuria and previous revascularisation.
- If no established disease is present, use the current NICE primary-prevention framework, including the special recommendations for type 1 diabetes and conditions in which risk may be underestimated.
Key medicines
Atorvastatin for primary preventionNICE recommends atorvastatin 20 mg once daily when its current primary-prevention criteria are met; confirm pregnancy status, interactions, baseline assessment and the live formulary before prescribing.
SGLT2 inhibitor classSelect the individual licensed product and dose from current NICE recommendations, renal thresholds, SmPC and local formulary; there is no safe universal class dose for every indication.