Type 2 diabetics with pre-existing CVD have poor glycemic control
MedWire News: Type 2 diabetic patients with pre-existing cardiovascular disease (CVD) have worse glycemic control than those without, report US researchers.
“Although there is a growing body of evidence showing that patients with Type 2 diabetes mellitus have poor glycemic control in general, it is not clear whether Type 2 diabetes mellitus patients with pre-existing CVD are more or less likely to have good glycemic control than patients without pre-existing CVD,” say Alex Fu (Cleveland Clinic, Ohio) and colleagues.
To investigate this further, Fu and team carried out a study of 1942 European patients with Type 2 diabetes who were selected from the Real-Life Effectiveness and Care Patterns of Diabetes Management (RECAP-DM) study cohort.
In total, 406 patients had CVD – defined as ischemic heart disease (67%), myocardial infarction (MI; 25%), stroke (12%), and peripheral vascular disease (24%) – and 1536 had no CVD at baseline.
The participants were followed-up for 4 years to assess their degree of glycemic control.
The investigators report in the journal Cardiovascular Diabetology that glycemic control was significantly better in Type 2 diabetics without CVD than in those with CVD.
For years 1, 2, 3, and 4, significantly fewer patients in the CVD than the non-CVD group had adequate glycemic control (defined as a glycated hemoglobin [HbA1c] below 6.5%), at 19.9%, 16.8%, 18.8%, and 16.8% versus 26.5%, 26.5%, 28.3%, and 23.5%, respectively.
Following adjustment for factors such as baseline differences, secular trend, and other confounders, patients with CVD were 38% less likely to have adequate glycemic control than those without CVD.
“The premise of the study is that, all other things being equal, patients with pre-existing CVD should have better glycemic control due to increased risk of future cardiovascular events,” comment Fu et al.
“Our study showed that patients at increased risk of cardiovascular events are not controlled any better than patients with lower risk (and in fact their control is worse).”
They conclude: “Since patients with pre-existing CVD have a higher risk of future diabetes-related complications, clinicians may want to pay more attention to glycemic control in these high-risk patients.”
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By Helen Albert