Sign up for our complimentary
weekly e-journal

Main Newsletter
Mastery Series
Therapy Series
Bookmark and Share | Print Article | Items for the Week Previous | All Articles This Week | Next
This article originally posted and appeared in  CardiovascularBG ControlPublic HealthIssue 638

Intensive Risk Management May Have No Effect

Intensively managing risk factors in patients newly diagnosed with diabetes in primary care does not have any significant effect on their cardiovascular outcomes compared with usual care.... 

The study found patients treated to tough HbA1c, cholesterol and blood pressure targets did not have significantly different risks of cardiovascular events after five years compared with those receiving standard diabetes care from GP practices.

The study provides further evidence to undermine moves to intensify diabetes treatment early on and provides evidence that standard GP care may be sufficient to prevent an increase in cardiovascular risk.

NICE raised the QOF HbA1c target in 2010 for patients with type 2 diabetes from 7.5% (58mmol/mol) to 7% (53mmol/mol), conceding that there was sufficient 'uncertainty' about patient safety to justify the move.

An analysis published in June also found aggressively lowering blood glucose in patients with type 2 diabetes only slightly reduces the risk of developing neuropathy, but greatly increased the risk of hypoglycemia.

This study finds that aggressive management to keep HbA1c levels below 7% (53mmol/mol), blood pressure below 135/85 mmHg, cholesterol below 5mmol/l and prescribing aspirin to those treated with antihypertensive medication did not significantly reduce their likelihood of having a cardiovascular event.

The research involved 379 general practices in Denmark, the Netherlands and the cities of Cambridge and Leicester, with each practice randomized to provide routine care after screening patients for diabetes or intensive multifactorial treatment. Over 3,000 patients without a history of ischemic heart disease were included in the final analysis, all aged between 40 and 69 years.

Routine care consisted of a standard pattern of diabetes care according to current recommendations applicable in each center. All patients with a cholesterol level over 3.5mmol/l were prescribed a statin.

Over five years, researchers found non-significant reductions in risk of 17% for a first cardiovascular event from diagnosis when comparing intensive treatment to routine care, and 30% for a second cardiovascular event.

When restricting cardiovascular events to include mortality, non-fatal myocardial infarction and non-fatal stroke, the risk reduction was only 14% when comparing the two groups.

The study authors concluded: "Early intensive multifactorial treatment was not associated with a significant reduction in total cardiovascular burden at five years."

"It remains to be seen whether intensification of early treatment in screen-detected individuals might translate into improved outcomes in the longer term."

Professor Mike Kirby, a GP in Radlett who participated in the study, said the results show that most practices were taking the right approach with their patients.

He said: "The standard of care was already good in most of the control practices, and this makes it difficult to show a difference."

"The use of statins, good blood pressure control and prescription of metformin made the difference, in my opinion."

But Dr. Roger Gadsby, a GP in Nuneaton and member of the NICE type 2 diabetes guideline development group, said the study follow-up period was too short to show positive outcomes.

He said: "In some intervention studies it can take up to 10 years for benefits to be demonstrated and so this negative result might just reflect the five years of the study."

"There is evidence early intensive glycemic control improves cardiovascular outcomes in the long term, but they were looking at 10-plus years of follow-up after the intervention."

Risk reductions for cardiovascular events comparing intensive treatment with routine care showed that, First event – 17%; Second event – 30%; Any event – 23%

 Diabetic Medicine 2012, online 23 July 



Bookmark and Share | Print | Category | Home

This article originally posted 09 August, 2012 and appeared in  CardiovascularBG ControlPublic HealthIssue 638

Past five issues: Issue 796 | Diabetes Clinical Mastery Series Issue 255 | Issue 795 | SGLT-2 Inhibitors Special Edition August 2015 | Diabetes Clinical Mastery Series Issue 254 |

2015 Most Popular Articles:

Coffee Consumption Proves Potential in Reducing Type 2 Diabetes Risk
Posted August 07, 2015
Impaired Glucose Uptake in the Brain May Increase Alzheimer's Disease Risk
Posted August 07, 2015
First Non-Surgical Weight Loss Procedure for Mild-to-Moderate Obesity
Posted August 07, 2015
GLP-1 Agonist Semaglutide Completes Phase III Trial with Positive Results
Posted August 07, 2015
Two New Possible Methods for Diagnosing and Monitoring Diabetes
Posted August 07, 2015
Impact of Switching Insulin Glargine to Insulin Detemir in T2 Patients
Posted August 14, 2015
Diabetes Combination Drug LixiLan Meets Main Target in Late Stage Trial
Posted August 07, 2015
SIgnificant Weight Gain Associated with Laparoscopic Sleeve Gastrectomy
Posted August 14, 2015
Ketoacidosis Not as Great as Thought in Diabetes Patients Taking Invokana
Posted August 13, 2015
A Telltale Sign of Type 2 Diabetes
Posted August 07, 2015

Browse by Feature Writer & Article Category.
A. Lee Dellon, MD | Aaron I. Vinik, MD, PhD, FCP, MACP | Beverly Price | Charles W Martin, DD | Derek Lowe, PhD | Dr. Brian Jakes, Jr. | Dr. Fred Pescatore | Dr. Tom Burke, Ph.D | Eric S. Freedland | Evan D. Rosen | Ginger Kanzer-Lewis | Greg Milliger | Kristina Sandstedt | Laura Plunkett | Leonard Lipson, M.A. | Louis H. Philipson | Maria Emanuel Ryan, DDS, PhD | Marilyn Porter, RD, CDE | Melissa Diane Smith | Michael R. Cohen, RPh, MS, ScD, FASHP | Paul Chous, M.A., OD | Philip A. Wood PhD | R. Keith Campbell, Professor, B.Pharm, MBA, CDE | Richard K. Bernstein, MD | Sheri R. Colberg PhD | Sherri Shafer | Stanley Schwartz, MD, FACP, FACE | Steve Pohlit | Steven V. Edelman, M.D. | Timothy S. Hollingshead |

Cast Your Vote
What percentage of your patients have reached goal for A1c, BP and cholesterol?

CME/CE of the Week
John Steinberg, DPM

Category: Diabetic Foot