/publications/issue/2009/September2009/DiabetesWatch-0909

Diabetes Watch

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For Diabetics with Heart Disease, Drug Therapy as Good as Surgery
Intensive drug therapy has the same benefit as prompt bypass surgery in many patients with type 2 diabetes, in terms of death related to strokes or heart attacks, according to new research. The results of a recent study—a multicenter trial led by the University of Pittsburgh Graduate School of Public Health—were presented at the American Diabetes Association’s (ADA) 69th Scientific Sessions in New Orleans.

The study enrolled 2368 patients with type 2 diabetes and stable coronary heart disease to determine the best way to reduce deaths and cardiovascular (CV) events—researchers compared drug-based treatment with 2 surgery approaches, either prompt bypass surgery or angioplasty, with intensive medical treatment alone.

Overall survival rates were 88%, said investigator Joel Zonszein from Montefiore Medical Center. Zonszein was very pleased with the low mortality rate of 12%; he said that CV-related mortality rates for diabetics are typically between 22% and 28%. He said that “the study reinforces that for people with diabetes and mild heart disease, medical therapy works... very well.” Richard Kahn, chief scientific and medical officer of the ADA, also said that adherence to a medication plan is key to heart health.


Risks Greater for Pregnant Women with Diabetes
An increasing number of women are either entering pregnancy with type 1 or 2 diabetes or develop gestational diabetes while pregnant, according to endocrinologist Sue Kirkman, vice president of clinical affairs for the American Diabetes Association. Pregnant women with diabetes may face a number of complications, says Kirkman, including an increased risk of miscarriages, delivery complications, maternal health problems, and birth defects. Risks can be reduced, however, with preconception counseling, tight control of blood sugar, and maintaining a healthy weight before and during pregnancy.

Women with pregestational diabetes (those who go into pregnancy already diagnosed with diabetes) should have hemoglobin A1C levels in the 6% to 7% range before conception, says Florence Brown, codirector of the Joslin Beth Israel Deaconess Medical Center’s Diabetes and Pregnancy Program in Boston. The results of a study published in the June 2009 issue of Diabetes Care showed that the risk of serious outcomes increased when A1C levels were >6.9%.


In Hospital Stay, Low Blood Sugar Signals Risk
During a hospital stay, patients with diabetes who experience just one episode of low blood sugar have a significantly increased risk of dying. In a new study, researchers found that, among the 2582 individuals with diabetes who were hospitalized for various reasons, low blood sugar occurred in roughly 8% of the patients. Each additional day with a hypoglycemic episode was linked with an 85% increase in the risk of death while hospitalized.

In addition, in patients who had hypoglycemia during their hospital stay, researchers found a 66% increased mortality risk for 1 year following discharge. Reporting in the July issue of Diabetes Care, researchers recommended that diabetes patients be more closely monitored to prevent low blood sugar.


Patients with Diabetes Helped by Early Treatment
In order to reduce the risk of heart problems and premature death, diabetes patients may benefit by aggressively lowering their blood sugar in the early years of the disease, researchers suggested recently at a symposium at the American Diabetes Association’s 69th Scientific Sessions in New Orleans.

Over the past year, the researchers have been analyzing data to better understand perplexing messages presented last year from 2 studies, the ACCORD study and the VA Diabetes Trial (VADT), that lowering blood sugar was related to death and may or may not be linked to increases in cardiovascular complications and heart-related deaths. Upon further investigation, researchers found that the timing of diabetes diagnosis was a factor. William Duckworth, cochair of VADT, said, “In general, the data show intensive treatment within the first 15 years of having diabetes has an increased chance of doing good, while intensive treatment after 15 years of having diabetes has an increased chance of doing harm.” More research is needed, say the researchers.


FAST FACT: Prediabetes, a silent condition, costs the United States $25 billion a year in medical costs.


For pharmacist-recommended diabetes products, visit: ww.OTCGuide.net. Click on: Diabetes Care.