DECODE Study De-Emphasises Importance
of Fasting Glucose
That, in contrast to post-load hyperglycemia,
as the principal measurable determinant of exposure
to the risk of cardiovascular disease in Type
2 diabetes.
Unravelling the precise association between cardiovascular
disease and Type 2 (non-insulin-dependent) diabetes
mellitus has proved problematic, largely as a
result of the confusing variety of diagnostic
criteria and methodologies used in previous studies
of disease-associated risk. More recently, improved
standardization and continuing refinements to
risk analyses have begun to clarify the relative
importance of individual risk factors for macrovascular
complications and progression to cardiovascular
disease. The evidence accumulated from several
large-scale epidemiological and intervention studies
strongly indicates that hyperglycemia and specifically
the post-load hyperglycemia resulting from postprandial
glucose excursions is the main factor associated
with increasing the risks of morbidity and mortality
in Type 2 diabetes.
The DECODE study has de-emphasized the importance
of fasting glucose, in contrast to post-load hyperglycemia,
as the principal measurable determinant
of exposure to the risk of cardiovascular disease
in Type 2 diabetes. Similarly, the Diabetes Intervention
Study identified mealtime hyperglycemia as an
independent risk factor for myocardial infarction
and all-cause mortality, while several other studies
have also shown that such mortality is better
predicted from post-challenge measurement criteria
rather than from fasting-glucose criteria.
It is likely that postprandial hyperglycemia
is an independent risk factor for atherosclerosis
and is also exerting an atherogenic effect indirectly
through the clustering of a number of risk factors
for atherosclerosis. Whether the relation between
post-load hyperglycemia and the risk of cardiovascular
events is causal is still not known. [Diabetologia
(2003) 46[Suppl1]:M17–M21]
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DID
YOU KNOW: The prevalence of hypertension
is increasing in the US, particularly among women,
non-Hispanic blacks, and older individuals after
an overall decline during the 1980s. Only about
one fourth of individuals with diabetes and hypertension
had blood pressure controlled to the target of
less than 130/85. Almost 29% of the adult US population
had blood pressure (BP) of 140/90 mm Hg or higher
in 1999-2000. (NHANES) AMA July 9, 03
