New research emphasizes importance of early interventions in type 2 diabetes

New research emphasizes importance of early interventions in type 2 diabetes

This article was originally published on EndocrinologyNetwork.com.

Treating and improving glucose control early could play a key role in reducing cardiovascular disease risk among patients with type 2 diabetes.

Analyzing data from the KORA study, results showed that achieving optimal glycemic control during the first 12 months of diagnosis was associated with improved prognosis when assessing the risk of cardiovascular events among patients with type 2 diabetes, with those who achieved glucose control in the year The first reduced the risk of cardiovascular disease by 25% while those who failed to treat high HbA1c saw a 21% increase in risk.

“Conventional wisdom has been to treat type 2 diabetes slowly and steadily through diet and escalation of medication dose over years—the period it takes for people to lower their sugar levels after diagnosis was thought to be less important for protecting major blood vessels. The observational study suggests that That controlling blood levels quickly—within the first twelve months after diagnosis—will help significantly reduce cardiovascular events,” study researcher Martin White, BA, PhD, and Reader in Metabolic Medicine at the University of Surrey, said in a statement. .

Citing data from the UK Prospective Diabetes Study which showed that early glycemic control was associated with reduced macrovascular events, White and a team of colleagues sought to assess whether early glycemic control after a diagnosis of type diabetes 2 May reduce the risk of major adverse cardiovascular disease In this sense, the researchers sought to perform a retrospective cohort analysis of adults with type 2 diabetes from the University of Surrey’s Research and Monitoring Center database (RCGP) of the University of Surrey, which contains Primary care records from 1,595,170 people. Registered from 164 practices in England.

To be included in the investigators’ analyses, individuals must have been newly diagnosed with type 2 diets on or after January 1, 2005, be at least 25 years of age or older at the time of diagnosis, and have HbA1c measurements at diagnosis and after 1 year plus 5 or more measurements after that. For the purpose of analysis, 3 glycemic ranges were generated: group A, B, and C. These groups were defined as having HbA1c levels less than 7.5%, 7.5-9.0%, and 9.0% or more, respectively. Movement between ranges from diagnosis to 1 year was used as exposures for the investigators’ analysis. The primary outcome of interest was the risk of major adverse cardiovascular events at diagnosis 1 year later, which the researchers assessed using Cox’s variable proportional hazards models that included first-year transition and the degree of glycemic variability.

In all, 26,180 individuals were identified for inclusion. This group was 43.9% female, the mean follow-up time was 1583 (IQR, 987-1737) days, mean BMI 30.7 ± 6.4 kg/m2, and at the time of data extraction, the mean age was . 68.7 ± 12.6 years. Preliminary analysis indicated that 48% of individuals started in band A and maintained this condition, 16.1% improved from band C to band A, and 14.6% improved from band B to band A from diagnosis to 1 year. The investigators noted that 7% of individuals started in band A but moved to band B or band C within the first 12 months.

Of the 26,180 patients included in the study, 4179 MACE events were recorded before type 2 diabetes diagnosis and an additional 1457 events were identified in the first 12 months after diagnosis. The investigators also noted 2,300 events occurring after one year.

Compared with those who maintained band A status from baseline to 1 year, those who transitioned from band C to band A within the first year had a lower risk of major adverse cardiovascular events (HR, 0.75 [95% CI, 0.60-0.94]; s= .014). In contrast, those who maintained the C-band status experienced an increased risk of significant adverse cardiovascular events (HR, 1.21). [95% CI, 0.81-1.81]; s= .34). When comparing risks based on the degree of glycemic variability, the results indicated that those with the highest levels of glycemic variability experienced an increased risk of events (HR, 1.51 [95% CI, 1.11-2.06]; s= .0096).

“Our findings support the concept that efforts should be made to achieve rapid metabolic normalization after diabetes diagnosis in those with a low propensity for hypoglycemia,” the researchers wrote.

This study, “Early and sustained glycemic control is associated with reduced major adverse cardiovascular events in people with type 2 diabetes: a primary care cohort study,” was published in Diabetes, obesity and metabolism.

2022-05-16 09:02:45

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