I just returned from the American Diabetes Association’s 68th Scientific Sessions held in San Francisco in June and I’d like to share some highlights:

Major Studies

ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation). The world's largest diabetes trial confirms the current approach that intensively controlling blood glucose has an important role in the prevention of the microvascular complications of type 2 diabetes, no evidence of any increased risk of death when blood glucose was intensively controlled.

Results of the blood pressure arm of the trial was published in the Lancet in September 2007, which showed that a fixed combination of perindopril and indapamide given to patients with type 2 diabetes, regardless of baseline blood pressure, reduced the risks of vascular events by 9% over the course of five years. The relative risk of cardiovascular death was reduced by 18%.

"If there is any effect of glucose control using currently available drugs on heart attacks, it's going to be small, and therefore the key message with heart attacks and strokes is that diabetes patients need comprehensive treatment to control all risk factors including blood pressure and cholesterol," said Dr. MacMahon.

ACCORD (Action to Control Cardiovascular Risk in Diabetes). The ADA reported that for the first time a previously unrecognized harm due to a strategy of intensified glucose lowering in high risk patients with type 2 diabetes has been identified. The trial had been studying whether a strategy of intensive control of blood glucose in type 2 diabetes could reduce the risk of cardiovascular disease. A safety review terminated its intensive treatment arm in February due to an increased death rate in the intensive treatment group. The intensively treated group had a 22% higher relative risk of all-cause mortality than the standard group, which translates to an absolute mortality increase of 1% over the 3.5 years of treatment and follow–up.

Dr. Robert Byington, PhD, head of the ACCORD coordinating center and Professor of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC, said "The major clinical implication is that there is some risk associated with this level of intensification of glycemic control in high risk cardiovascular patients with type 2 diabetes similar to ACCORD patients and that has to be considered by clinicians in the management of the disease." Please note, all ACCORD patients were at high risk. 35% had had a prior CVD event such as a heart attack or stroke prior to the trial and the balance of the participants had subclinical cardiovascular disease or major cardiovascular risk factors.

People in the intensive group did have a 24% lower risk of nonfatal heart attacks. There was no difference between the groups in the rate of nonfatal strokes and heart failure.

It is still not clear why the increased mortality with the intensive glycemic control arm. The blood pressure and lipid control arms of the study continues.

VA Diabetes Trial

This long-term trial studied whether intensive blood glucose control would reduce the risk of cardiovascular disease found in a reduction in events.  The report presented showed it was not statistically significant.

"While we found that intensive treatment of patients with type 2 diabetes suggested some benefits from glucose control, it did not reach significance for a reduction in the primary endpoint -- a composite of specified cardiovascular disease events -- in this population," said William C. Duckworth, MD, Director of Diabetes Research, Carl T. Hayden VA Medical Center in Phoenix, Professor of Clinical Medicine, University of Arizona, and Co-Chair of the trial.

Two Important Diabetes Links

Sleep. Due to a high correlation of Obstructive Sleep Apnea (OSA) and type 2 diabetes (up to 50%), Dr. Paul Zimmet, MD PhD, Foundation Director of the International Diabetes Institute in Melbourne, Australia and co-chair of the IDF Task Force on Epidemiology and Prevention, presented IDF's consensus statement recommending that all patients receiving treatment for either OSA or type 2 diabetes should be screened for the other condition.

Oral Health. A symposium, Links Between Periodontal Disease and Diabetes taught us how periodontitus is associated with the development of type 2 diabetes and it’s complications. Oral disease treatment can help control hyperglycemia. Teach your patients to see and follow their dentists’ recommendations, and ask to be screened for periodontal disease.  If positive, see a periodontist for treatment.

EnJOY!

Editor’s note: Diabetes Health Professional is grateful to have had Joy Pape as its Guest Editor for over a year. We are looking forward to implementing our original vision of inviting a different guest editor each month to write a column on some professional aspect of the diabetes community. We look forward to publishing Joy again in the future.

Joy Pape can be reached at joy@joypape.com