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- September 9, 2010 |
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| Presentation |
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"Glycemic intervention studies in type 2 DM: implications for patient care"Dr. Lawrence A. Leiter (biography)
English - 2009-08-14 - 40 minutes
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Summary :
In this presentation Dr. Leiter reviews updated evidence from trials looking at the role of glycemic control in reducing the risk of diabetic complications.
There is evidence to support the concept of “earlier is better” for glycemic control in the prevention of cardiovascular (CV) complications, in type 1 and type 2 diabetic patients. In type 1 patients, the 10-year EDIC observational study showed that intensive treatment in the preceding DCCT trial had long-term benefits on CVD risk. This “metabolic memory,” implies that the earlier glucose levels are optimized, the greater the long-term benefit. In the UKPDS there was a similar “legacy effect” in type 2 patients, even though in both studies the long-term follow-up showed that the difference in HbA1c achieved during the trial was not maintained.
More recently, the ACCORD trial showed greater reductions in cardiovascular endpoints in type 2 diabetic patients having no previous CV events, and in those having better glycemic control (HbA1c less than 8 percent), suggesting again that early intervention is better. Three recent trials in type 2 patients, the ADVANCE, ACCORD and VADT, have confirmed the relationship observed in the UKPDS between intensive glycemic control and reduction in microvascular complications, however only nonsignificant reductions were seen for macrovascular complications. Dr. Leiter discusses the possible influence of longer duration of diabetes at study entry, since, unlike the UKPDS participants who entered the study newly diagnosed, the recent study participants had diabetes for several years, leaving more time for atherosclerosis to develop in advance.
Finally, intensive glucose control may not be suitable for all patients, as in the ACCORD study the mortality rate appeared to be higher in the intensive arm. Various hypotheses to explain this effect were discussed at the 2009 American Diabetes Association meeting. Dr. Leiter presents more new data on the comparative effects of antihyperglycemic agents from the BARI-2D and RECORD trials, and ends with some general conclusions.
Copyright © 2009 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Long-term reductions in cardiovascular outcomes associated with earlier glycemic control in type 1 and type 2 diabetic patients
- Evidence for “earlier is better” regarding glycemic control in type 2 patients
- Data suggesting harm from intensive treatment in some patients
- Current Canadian glycemic targets
- Treatment in patients with coronary artery disease
Bibliographic references :
The Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group Effect of Intensive Therapy on the Microvascular Complications of Type 1 Diabetes Mellitus JAMA Vol. 287 No. 19, May 15, 2002.
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 Diabetes NEJM Volume 353:2643-2653.
Peter Gæde, M.D., D.M.Sc., Henrik Lund-Andersen, M.D., D.M.Sc., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc. Effect of a Multifactorial Intervention on Mortality in Type 2 DiabetesNEJM Volume 358:580-591.
Rury R. Holman, F.R.C.P., Sanjoy K. Paul, Ph.D., M. Angelyn Bethel, M.D., David R. Matthews, F.R.C.P., and H. Andrew W. Neil, F.R.C.P. 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes NEJM Volume 359:1577-1589.
The Action to Control Cardiovascular Risk in Diabetes Study GroupEffects of Intensive Glucose Lowering in Type 2 Diabetes N Engl J Med. 2008 Jun 12;358(24):2545-59.
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