A more conservative approach to aspirin for primary prevention in adults with diabetes is called for in a joint statement issued today by diabetes and cardiovascular associations.
Low-dose aspirin can be considered reasonable for diabetes patients with a cardiovascular disease risk above 10% over 10 years and no excess bleeding risk, according to the statement released by the American Heart Association, the American Diabetes Association, and American College of Cardiology.
I know people have been asking about drinking and being diabetic, and it’s a very honest question,” he blogged. “Here is the honest answer, and this is the truth: when I say ‘party’ and ‘let’s have fun,’ I’m one of those guys that just likes to have a great time. I’m not a belligerent drunk. I don’t need to drink. … For a diabetic … it’s a double whammy because here’s what happens with alcohol: when you’re hung-over then you don’t eat right, you don’t take your insulin right. So it’s best to stay away. But, I pick and choose my times when I’m going to have fun.
Reality star and aging rocker Bret Michaels, just weeks before his cerebral hemorrhage.
During 2004–2008, 7.6% of adults overall in the United States reported ever having been told they had diabetes. American Indian/Alaska Natives (17.5%), blacks (11.8%), and Hispanics (10.6%) were more likely than Asians (8.0%) and whites (6.6%) to report ever having been told by a doctor or health professional that they had diabetes.
More than 40% of people with undiagnosed diabetes had chronic kidney disease, based on albuminuria or reduced estimated glomerular filtration rate (eGFR) — just as many as in those with diagnosed diabetes, according to Laura C. Plantinga, ScM, of San Francisco General Hospital and University of California San Francisco, and colleagues.
Notably, 56.2% of chronic kidney disease was stage 3 or 4 among those with prediabetes, indicated by a fasting plasma glucose between 100 and 126 mg/dl, and for whom kidney dysfunction was likely unsuspected.
From April 2005 to October 2008, FDA received 78 reports of altered kidney function in patients treated with Byetta. Some of the patients had pre-existing kidney disease and other risk factors for developing kidney problems. Acute renal failure occurred in 62 patients and renal insufficiency in 16 patients.
Newer Blood Test Predicts Diabetes, Heart Disease – BusinessWeek
For the current study, Selvin and her colleagues measured A1C from more than 11,000 stored blood samples from the Atherosclerosis Risk in Communities Study, which began in 1990. None of the study volunteers had diabetes or cardiovascular disease at the time the blood samples were taken.
The researchers then compared the A1C levels to fasting blood sugar levels and to the 15 years of overall health follow-up information gathered for the previous study.
During that time, 2,251 people were diagnosed with diabetes, nearly 1,200 were diagnosed with heart disease and 358 people had an ischemic (non-bleeding) stroke, according to the study.
As expected, the researchers found that elevated A1C levels were associated with an increased risk of being diagnosed with diabetes. Those with an A1C of less than 5 percent had a 48 percent reduced risk of diabetes, while people whose A1Cs were between 5 and 5.5 percent had a normal risk of diabetes. From there, however, the risk quickly went up. Those with an A1C of 5.5 to 6 percent had an 86 percent increased risk of diabetes. For those between 6 and 6.5 percent, the risk more than quadrupled. For people with levels above 6.5 percent, the odds of being diagnosed were more than 16 times higher than for someone with levels under 5.5 percent. These results were similar to those for fasting glucose levels, the study authors noted.
Where fasting glucose and A1C differed greatly, however, was in the prediction of future heart disease and stroke risk. While fasting glucose failed to predict future risk, the study found that A1C levels accurately did so.
People with A1Cs under 5.5 percent had an average risk of heart disease and stroke, but for people with an A1C between 5.5 and 6 percent, the risk went up 23 percent. For those with an A1C between 6 and 6.5 percent, the risk of cardiovascular disease jumped to 78 percent. When A1C went over 6.5 percent, the risk of cardiovascular disease went up nearly twofold.
Results of the study are published in the March 4 issue of the New England Journal of Medicine.
NEJM — Weighing Risks and Benefits of Liraglutide — The FDA’s Review of a New Antidiabetic Therapy
On January 25, 2010, the FDA approved liraglutide, a glucagon-like-peptide-1 (GLP-1) receptor agonist that can be taken once daily to improve glycemic control in adults with type 2 diabetes.
RESULTS There were 160 deaths (24.6%) during follow-up, with 70 (43.8%) due to CVD. In Kaplan-Meier survival analysis, there was no difference in either CVD or all-cause mortality in aspirin users versus nonusers (P = 0.52 and 0.94, respectively, by log-rank test). After adjustment for significant variables in the most parsimonious Cox models, regular aspirin use at baseline independently predicted reduced CVD and all-cause mortality (hazard ratio [HR] 0.30 [95% CI 0.09–0.95] and 0.53 [0.28–0.98[, respectively; P ≤ 0.044). In subgroup analyses, aspirin use was independently associated with reduced all-cause mortality in those aged ≥65 years and men.
CONCLUSIONS Regular low-dose aspirin may reduce all-cause and CVD mortality in a primary prevention setting in type 2 diabetes. All-cause mortality reductions are greatest in men and in those aged ≥65 years. The present observational data support recommendations that aspirin should be used in primary CVD prevention in all but the lowest risk patients.
CONCLUSIONS Increased CIMT was significantly related to the presence and extent of abnormal myocardial perfusion. Assessment of CIMT may be useful to identify asymptomatic patients with type 2 diabetes at higher risk for CAD.
RESULTS Increased CIMT was an independent predictor of the extent of abnormal perfusion (P < 0.001). In patients with increased CIMT as compared with patients with normal CIMT, abnormal perfusion (75 vs. 9%) and severely abnormal perfusion (28 vs. 3%) were observed more frequently.
Byetta (exenatide) – Renal Failure
From April 2005 through October 2008, FDA received 78 cases of altered kidney function (62 cases of acute renal failure and 16 cases of renal insufficiency), in patients using Byetta. Some cases occurred in patients with pre-existing kidney disease or in patients with one or more risk factors for developing kidney problems.
Oops.
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