Oral Medications

Aspirin and Diabetes

Aspirin is known to decrease the risk of heart attacks and strokes. For most people with diabetes, it's probably a good idea to take one every day.

One aspirin a day, whether a standard inexpensive tablet, or a coated or buffered version, or even a "baby aspirin," has been shown to decrease the risk of heart attacks and strokes. Since people with diabetes are at increased risk of these devastating problems, it seems reasonable that most people with diabetes take an aspirin tablet daily.

When to start?

There are now studies showing the effectiveness of using aspirin in people with diabetes, but it's still a guess as to whether to wait till trouble shows up to start aspirin, or to start earlier. It's certainly reasonable to start it when there's evidence of blood vessel disease, either extra noises in the blood vessels (called bruits) heard through the doctor's stethoscope, or other evidence of vascular damage. But aspirin is generally a safe drug, and perhaps we should consider recommending it for every adult with diabetes. The American Diabetes Association has given its criteria for starting it.

When to avoid using aspirin?

There are several circumstances where it's obvious that it would be would be wiser to avoid taking aspirin:

• Bleeding disorders, including bleeding ulcers, and bleeding in the retinal area of the eyes.
• Use of other drugs that interfere with clotting, such as Coumadin, heparin, and Ticlid.
• Active stomach or duodenal ulcer disease
• Allergy to aspirin, or severe gastrointestinal distress from aspirin

Other comments

• Taking aspirin will probably make it a bit easier for you to get blood from your fingertip for blood sugar monitoring.
• You may have more bruises at the sites of injection of your insulin shots.
• Be sure to check with your doctor before starting aspirin therapy

Aspirin Therapy in Diabetes

Recommendations

1. Use aspirin therapy as a secondary prevention strategy in diabetic men and women who have evidence of large vessel disease. This includes diabetic men and women with a history of myocardial infarction, vascular bypass procedure, stroke or transient ischemic attack, peripheral vascular disease, claudication, and/or angina.
2. In addition to treating the primary cardiovascular risk factor(s) identified, consider aspirin therapy as a primary prevention strategy in high-risk men and women with type 1 or type 2 diabetes. This includes diabetic subjects with the following:
   • A family history of coronary heart disease
   • Cigarette smoking
   • Hypertension
   • Obesity (>120% desirable weight); BMI >27.3 in women, >27.8 in men
   • Albuminuria (micro or macro)
   • Lipids:
   • Cholesterol >200 mg/dl
   • LDL cholesterol >100 mg/dl
   • HDL cholesterol <45 mg/dl in men
   • and <55 mg/dl in women
   • Triglycerides >200 mg/dl
   • Age >30 years
   • Use of aspirin has not been studied in diabetic individuals under the age of 30 years.

Use enteric-coated aspirin in doses of 81–325 mg/day

People with aspirin allergy, bleeding tendency, anticoagulant therapy, recent gastrointestinal bleeding, and clinically active hepatic disease are not candidates for aspirin therapy.

Aspirin therapy should not be recommended for patients under the age of 21 years because of the increased risk of Reye's syndrome associated with aspirin use in this population.