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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ECardiovascular disease (CVD) is one of the primary clinical risks that are associated with type 2 diabetes. While a clear graded association of CVD risk has been noted with hyperglycemia, the role of glucose control in CVD risk mitigation remains uncertain. This article discusses data from the UK Prospective Diabetes Study [UKPDS] Group, the relationship between atherosclerosis and diabetes, the ARBITER 6-HALTS Trial, and blood glucose control by sulphonylureas or insulin.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eprevention \u0026amp; screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiometabolic disorder\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehyperglycemia\/hypoglycemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elipid disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ediabetes mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003ECardiovascular disease (CVD) is one of the primary clinical risks that are associated with type 2 diabetes. While a clear graded association of CVD risk has been noted with hyperglycemia, the role of glucose control in CVD risk mitigation remains uncertain. This issue was addressed by Darren K. McGuire, MD, University of Texas Southwestern Medical Center, Dallas, TX. Referencing data from the UK Prospective Diabetes Study (UKPDS) Group, Dr. McGuire noted that intensive blood glucose control by either sulphonylureas or insulin substantially decreased the risk of microvascular complications, but not macrovascular disease, in patients with type 2 diabetes [UKPDS Group. \u003Cem\u003ELancet\u003C\/em\u003E 1998].\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAnother study from this same group investigated whether intensive glucose control with metformin attenuated the risk of heart attacks [UKPDS Group. \u003Cem\u003ELancet\u003C\/em\u003E 1998]. Compared with the conventional treatment group, patients who were allocated to metformin had risk reductions of 32% (95% CI, 13 to 47; p=0.002) for any diabetes-related endpoint (need to list components), 42% for diabetes-related death (p=0.017), and 36% for all-cause mortality (p=0.011). Among patients who were allocated to intensive blood glucose control, metformin showed a greater effect than chlorpropamide, glibenclamide, or insulin for any diabetes-related endpoint (p=0.0034), all-cause mortality (p=0.021), and stroke (p=0.032) [UKPDS Group. \u003Cem\u003ELancet\u003C\/em\u003E 1998]. A meta-analysis of five trials confirmed these findings. Intensive glycemic control resulted in a 17% reduction in events of nonfatal myocardial infarction (OR, 0.83; 95% CI, 0.75 to 0.93) and a 15% reduction in coronary heart disease events (OR, 0.85; 95% CI, 0.77 to 0.93) but no significant effect on events of stroke or all-cause mortality [Ray KK et al. \u003Cem\u003ELancet\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/2\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022UKPDS Metformin Substudy: CHD Events.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-580082540\u0022 data-figure-caption=\u0022UKPDS Metformin Substudy: CHD Events.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/2\/23\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/2\/23\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/2\/23\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11212\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EUKPDS Metformin Substudy: CHD Events.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from D. McGuire, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAs the prevalence of diabetes approaches 10% of the population of the United States and the number of antihyperglycemic medications on the market increases, there are converging pressures for regulatory changes. In part, this has been driven by concerns that some of these therapies may be associated with increased cardiovascular risk. Guidance from the US FDA to the industry states that \u201csponsors should demonstrate that the therapy will not result in an unacceptable increase in cardiovascular risk.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EAtherosclerotic disease is prevalent in diabetic patients and accounts for significant morbidity and mortality. Danielle Duffy, MD, Thomas Jefferson University, Philadelphia, PA, discussed the appropriate lipids goals for diabetic patients and how to achieve them.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe Adult Treatment Panel III of the National Cholesterol Education Program issued an evidence-based set of guidelines on cholesterol management in 2001 that confirmed the benefit of cholesterol-lowering therapy in diabetic patients. The guidelines support a treatment goal of low-density lipoprotein cholesterol (LDL-C) \u0026lt;100 mg\/dL in this population, as this population are felt to be at equivalent risk to patients with known cardiovascular disease.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ELarge-scale clinical trials and a meta-analysis [Sattar N et al. \u003Cem\u003ELancet\u003C\/em\u003E 2010] confirmed the benefits of statin use in diabetic patients to lower lipids. In one study, 40 mg simvastatin daily reduced the rate of first major vascular events by about 25% in a wide range of diabetic patients [Collins R et al. \u003Cem\u003ELancet\u003C\/em\u003E 2004]. Niacin treatment, added to statin monotherapy to further modify the lipid profile (raise HDL, further reduce triglycerides and LDL), caused a significant regression of carotid intima-media thickness in the ARBITER 6-HALTS trial [Taylor AJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EIn summary, Dr. Duffy noted that a target LDL-C \u0026lt;70 mg\/dL remains the primary lipid goal for patients with diabetes, with statins the first-line choice for lipid lowering.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EA target-driven, long-term, intensified intervention that is aimed at multiple risk factors in patients with type 2 diabetes and microalbuminuria has been shown to reduce the risk of cardiovascular and microvascular events by about 50% [Gaede P et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2003]. Donna M. Polk, MD, University of California, Los Angeles, CA, outlined such an intervention strategy, known as the ABCs of care for providers of diabetic patients.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11215\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11215\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11215\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003EABCs of Care for Providers of Diabetic Patients.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/2\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmtg2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmtg2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmtg2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}