Physicians' Academy for Cardiovascular Education

Immediate intensive treatment after T2DM diagnosis is beneficial

News - Sep. 30, 2013


Presented at the EASD in Barcelona

Waiting with the start of intensive glycaemic control in patients with newly diagnosed type 2 diabetes (T2DM) seems to increase future cardiovascular risk.

A large retrospective study suggests that patients with a consistently increased HbA1c (>7%), for whom there was a delay of 6 months before treatment was intensified, had a higher risk of myocardial infarction (HR: 1.38, 95%CI: 1.16-1.62), heart failure (HR: 1.28, 95%CI: 1.10-1.48) and a composite of cardiovascular  events (HR: 1.25, 95%CI: 1.13-1.39), in about 5 years follow-up.

Data of 105477 adult patients from the UK clinical practice research database who had received the diagnosis T2DM were analysed. The average HbA1c at diagnosis was 8.1%. Of those with poor glycaemic control, 25% did not receive intensive treatment (defined as at least two oral diabetic drugs or 1 oral drug and insulin).

After correction for age at diagnosis, sex, smoking status, use of cardioprotective medication and cardiovascular event history, delay of the use of intensive treatment in the case of persistingly poor glycaemic control was associated with a higher cardiovascular risk. These effects were generally independent of whether the patient had already experienced a cardiovascular event before receiving the T2DM diagnosis.

These results suggest and confirm that the cardiovascular risk on the long run is larger if intensive treatment is not commenced early after diagnosis. These findings are similar to those of the UK Prospective Database Study that showed that better glycaemic control in patients with a recent diagnosis of T2DM was associated with a lower risk 10 years later of myocardial infarction and all-cause mortality. Other large trials might not have shown a cardiovascular benefit of increased glycaemic control because they included patients with existing diabetes and thus worse beta cell function.

It appears as though intensification of the treatment at a later stage has less effect. Whether this concerns a causal relationship or a general effect of differences in quality of care, remains to be determined.
 

Reference

Paul S, et al "Delay in treatment intensification increases the risk of cardiovascular events in patients with type 2 diabetes" EASD 2013; Abstract 1338.