An article published in the May 2010 issue of Postgraduate Medicine highlights the seriousness of cardiovascular disease (CVD) in patients with type 2 diabetes. Cardiovascular disease is the cause of death in > 65% of patients with diabetes, and when complicated by the presence of obesity, the lifetime risk of developing CVD increases to 90%. The inherent problem is that many of the antihyperglycemic medications used to combat high glycated hemoglobin are associated with weight gain and/or hypoglycemia, which negatively affect CVD.
The article reviews the results of three large-scale type 2 diabetes cardiovascular outcome trials—the Action to Control Cardiovascular Risk in Diabetes trial, the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial, and the Veterans Affairs Diabetes Trial— of the effect of glucose control on reducing the risk of microvascular and macrovascular complications associated with type 2 diabetes. The author, Carol H. Wysham, MD, explains how clinicians can select appropriate treatment strategies for their patients, not only to control glucose levels but to prevent further CVD complications, including dyslipidemia, hypertension, hypoglycemia, and weight gain. Analysis of the aforementioned trials showed that benefits of intensive therapy in patients with long-duration type 2 diabetes, and a significant percentage of patients with prior cardiovascular events, were difficult to prove.