Monaldi Arch Chest Dis 2003; 60: 4, 263-282 POSITION PAPER Raccomandazioni per la riabilitazione cardiovascolare nel paziente con Diabete Mellito Reccomandations for cardiovascular rehabilitation in Diabetes Mellitus Per il Gruppo Italiano di Cardiologia Riabilitativa e Preventiva (GICR): Alberto Camerini (coordinatore), Carmine Chieffo*, Raffaele Griffo, Marco Comaschi**, Marinella Gattone^, Edoardo Mannucci # , Ezio Faglia^^, Carlo Giorda°, Maria Luisa Biorci, Francesco Fattirolli°° U.O. C. Cardiologia Riabilitativa, Ospedale La Colletta, Arenzano (GE). * U.O. Cardiologia Riabilitativa, Dipartimento di Cardiologia A.O. Caserta. ** U.O Medicina Generale, Ospedale La Colletta, Arenzano. ^ Divisione di Cardiologia, Fondazione S. Maugeri, Istituto di Veruno (NO). # Dipartimento di Area Critica Medico Chirurgica, Unità Funzionale di Geriatria, Sezione di Diabetologia. Università di Firenze. ^^ Divisione di Medicina Interna, Policlinico Multimedica, Sesto S. Giovanni (MI). ° U.O Malattie metaboliche e diabetologia, ASL 8 Regione Piemonte. °° Centro Regionale per la Riabilitazione Cardiologica, A.O.U. Careggi, Firenze. Corrispondenza: Dott. A. Camerini, U.O.C. Cardiologia Riabilitativa, Ospedale La Colletta; Via del Giappone 6, 16011 Arenzano (GE); e-mail: a.camerini@email.it ABSTRACT: Reccomandations for cardiovascular rehabil- itation in Diabetes Mellitus. Per il Gruppo Italiano di Car- diologia Riabilitativa e Preventiva (GICR): A. Camerini (coordinatore), C. Chieffo, R. Griffo, M. Comaschi, M. Gat- tone, E. Mannucci, Ezio Faglia, Carlo Giorda, Maria Luisa Biorci, Francesco Fattirolli. Cardiac rehabilitation is accepted as an important component in the management of heart disease. Diabetes Mellitus is a chronic disease frequently associated to is- chemic heart disease and both disease require continuing medical care, aggressive treatment of other risk factors, educational programs for self management of disease to prevent acute complication. The scientific community should offer standard of care for management of diabetic patients with coronary artery disease, and should designe new strategies to promote prevention in this high risk pa- tients. The need to define characteristics and peculial problems of diabetics patients with ischemic heart disease encouraged the Board of the Italian Group of Cardiac Re- habilitation and Prevention (GICR) to set up a working group composed of cardiologists and diabetologists chosen on the basis of their proven specific experience. The docu- ment is subdivided in six parts. In the first section is de- scribed the cardiovascular risks in patients with diabetes and the importance of post-prandial hyperglycemia and glycemic variability. We analyse also the difference in prevalence of ischemic heart disease in Italian diabetic pa- tients compared with other countries. In the second section we described clinical presenta- tion of ischemic heart disease in diabetic patients such as acute myocardial infarction and unstable angina, and the revascularization procedures (balloon angioplasty and coronary bypass surgery). We analysed the differences between the procedures and the evidence-based results. In patients with myocardial infarction we analysed the evidence-based therapy and specific advantages of as- pirin, beta-blockers and ace-inibitor in diabetic patients. In this section we also posed particular attention to the clinical course of patients who underwent bypass grafting and to the impact of diabetes on short and long-term re- sults and on main intervention-related complications in- cluding deep infections, mediastinitis, neurological prob- lems, renal failure. In the third section we evaluated the factors resposi- ble of atherosclerosis progression and their treatment, and we underlined that cardiac rehabilitation is less effective for patients with diabetes mellitus. Suggestions proposed in this paper about risk factors are in line with the recom- mendations of standards guidelines of American Diabetics Association. In patients with concomitant diabetes and is- chemic heart disease we suggest blood pressure <130/80, LDL-cholesterol <100 mg/dl, triglicerides <150 mg/dl and daily physical activity. In the fourth section we analysed therapeutic regi- mens and management of diabetes. We posed particular attention on insulin therapy in acute phase of myocardial infarction and in recent coronary bypass grafting, and chronic use of oral antidiabetic drugs or insulin. In the fifth section we provided some reccomanda- tions on the organization of educational programs and physical activity in these patients. In the last section we provided some information on diagnosis of coronary artery disease in diabetes, aim of screening and in which patients is need to perform diagnostic tests. We described the available diagnostic tests with the differences in each method. Keywords: Cardiac rehabilitation, diabetes mellitus, ischemic heart disease. Monaldi Arch Chest Dis 2003; 60: 4, 263-282.