The pathogenesis of atherosclerosis and vascular thrombosis in NIDDM is reviewed. Evidence that suggests a role for chronic hyperglycemia, in association with other vascular risk markers, is presented. Based on this framework, a multifactorial approach to the prevention of progression of macrovascular disease in NIDDM is discussed. Results from a recent consensus conference sponsored by the American Diabetes Association regarding approaches to glycemic regulation in people with NIDDM are reviewed. It is concluded that preventive approaches will materially alter the course of macrovascular disease, reduce health care costs, and improve the quality of life for people with NIDDM.

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