Diabetes and Cardiovascular Disease Prevention: Where Are We Now?

AADE General Session
Thursday August 12, 2004
Reviewed by Aric Fader, PhD

Management of type 2 diabetes should focus on decreasing the impact the disease has on the quality of life of patients, especially by addressing on the factors associated with cardiovascular disease (CVD). Until recently treatment of type 2 focused on glycemic control, which is difficult to manage, in order to limit diabetic microvascular complications (DMC) and diabetic macrovascular complications, but research has revealed that self management and combination therapy may provide further benefits. The recognition of diabetes as a vascular disease and the association between hypertension and CVD risk over the last 10 years has lead to the development of many new drug therapies, such as multi-factorial hypertension and weight loss treatments.

Lowering of glucose levels in patients with type 2 diabetes was shown to decrease the incidence rate of DMC, but there has been no proof of correlation between decreased glucose and improvements in rates of macrovascular disease over time. Therefore, type 2 patients must also receive therapies for control of blood pressure and lipids, and well as changes in lifestyle, along with glycemic control. Other data obtained over the last 15 years have shown that the treatment goals need to be adjusted. For example, obtaining low-density lipids (LDL) below 100 or perhaps even 70, may not be sufficient for preventing or treating diabetic complications. In addition, lowering LDL among patients suffering from diabetes is difficult to achieve, and although statins may help, lifestyle changes are necessary.

Based on those findings, Dr. Kendall has put a great deal of thought into designing studies that may provide healthcare professionals with means to improve the outcomes of their patients. The elements that contributed to his work include the fact that high-density lipids (HDL) can help patients with either type 2 diabetes or insulin resistance, and that treatments such as fibrate can help with HDL levels. Many blood pressure treatments may help patients suffering from diabetic macrovascular complications and/or DMC. Although hypertension is difficult to treat and can require 3 or 4 treatments daily, aspirin does provide many benefits. The fact that only 37% of patients that have been diagnosed with CVD receive aspirin demonstrates the need for further education among healthcare providers. In addition, weight loss and physical activity may be the only things that could address all of the complications associated with diabetes.

As a result of the work they have completed thus far, Dr. Kendall and his research team won the American Medical Association Award once they were able have 20% of their patient population reach all treatment goals. Since they believe that it is possible to have a much greater proportion of patients reach those goals, they are conducting a large, ongoing study entitled Action to Control Cardiovascular Risk in Diabetes (ACCORD). The ACCORD Trial was designed to determine which methods can be employed to lower patients’ hemoglobin A1C levels by at 1.5%, and the enrollment of patients for that study has been completed. The release date for data obtained from that trial is projected to be in 2009, and Dr. Kendall hopes that those results will be able to alter treatment guidelines in a manner that will help all patients suffering from diabetes.