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Cardiovascular Health and Type 2 Diabetes

We present 3 studies that show the importance of managing cardiovascular risks in your diabetic patients.

The number one cause of death and disability in type 2 diabetes (T2DM) patients is heart disease and stroke. From 2003-2006, CV disease death rates were approximately 1.7 times higher in adults over 18 years old with diabetes compared to adults without diagnosed diabetes. In 2010, hospitalization rates for heart attack and stroke were 1.8 and 1.5 times higher among diabetics aged 20 years and over, respectively. We present 3 studies that show the importance of managing cardiovascular (CV) risks in your diabetic patients.

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Reference: Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014. Accessed 19 May 2015.

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Hypertension & Diabetes Are Risk Factors for Cognitive Decline

• Patients with both conditions are especially at risk.

• 713 individuals participated, 201 had T2DM.

• Researchers investigated links between 24-hour blood pressure and cognitive performance.

• Nocturnal dipping status was also checked regarding cognitive decline (686 individuals, 196 with T2DM).

• Quadratic associations (inverted U-shaped) were found with diastolic BP and cognitive performance in T2DM patients, but not in control subjects.

• No pattern was determined for dipping status.

• In T2DM patients, both high and low diastolic BP are associated with decreased information processing speed and memory.

Reference: Spauwen PJ, et al. Both low and high 24-hour diastolic blood pressure are associated with worse cognitive performance in type 2 diabetes: the Maastricht Study. Diabetes Care. Online publication 27 May 2015.

Glycemic Control & Cardiovascular (CV) Outcomes in T2DM Patients

• 1791 veterans with T2DM were treated with intensive glucose-lowering or standard therapy.

• At approximately 5.6 years follow up, intensive therapy did not diminish the rate of major CV events.

• After the trial, follow-up data for 94.6% of participants were collected; 77.7 % of this group completed annual surveys and periodic chart reviews.

• Primary outcome was time to major CV event and secondary outcomes were CV mortality and all-cause mortality.

• On average follow up of 9.8 years, the intensive-therapy group had a much lower risk of primary outcome than the standard-therapy group.

• The intensive-therapy group had an absolute reduction in risk of 8.6 major CV events per 1000 person-years, but no reduced CV mortality or total mortality.

Reference: Hayward R, et al. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes. N Engl J Med. Online publication 4 June 2015.

Early Detection & Treatment of T2DM Decreases CV Morbidity and Mortality         

• Researchers evaluated the benefits of screening and early detection of T2DM compared to no screening and late treatment using a simulation model.

• The model estimated the absolute risk of CV outcomes and the reduction of risk associated with screening and intensive treatment, screening and routine treatment, and no screening with a 3- or 6-year delay in diagnosis and routine treatment.

• The simulated absolute and relative risk reductions were much greater at 5 years with screening, early diagnosis, and routine treatment.

• With a 3-year delay, there was a 3.3% absolute risk reduction and a 29% relative risk reduction.

• With a 6-year delay, there was a 4.9% absolute risk reduction and a 38% relative risk reduction.

• The intensity of blood pressure, glucose, and cholesterol treatment after diagnosis was less important than when treatment was initiated.

Reference: Herman WH, et al. Early detection and treatment of type 2 diabetes reduces cardiovascular morbidity: a simulation of the results of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION-Europe). Diabetes Care. Online publication. 18 May 2015.

Take-home Points

• Both high and low diastolic BP are associated with decreased information processing speed and memory in T2DM patients.

• T2DM patients with intensive glucose control had fewer major CV events, but there was no improvement in overall mortality compared to controls.

• Screening for T2DM to reduce time between diagnosis and treatment greatly reduces CV risk factors.