Patients with diabetes may not receive best treatment to lower heart disease risk
For some people with diabetes, there may be such a thing as too much care.
Traditional treatment to reduce risks of heart disease among patients with diabetes has focused on lowering all patients' blood cholesterol to a specific, standard level. But this practice may prompt the over-use of high-dose medications for patients who don't need them, according to new research from the VA Ann Arbor Healthcare System (VAAAHS) and the University of Michigan Health System.
The study encourages a more individualized approach to treatment that adjusts treatment according to the patient in order to improve the quality of care. The findings appear in Circulation: Cardiovascular Quality and Outcomes.
Authors also suggest that blanket goals routinely used to lower heart attack risks may unnecessarily expose some patients to potential adverse side effects of high-dose medications. Researchers also note that when these standard goals are used to assess whether a health provider delivered high quality care, they may encourage overly aggressive treatment.
"We want patients to get the treatment they need to prevent heart attacks and cardiovascular issues but we don't want to expose them to additional treatment risks without strong evidence of the benefits," says senior author Eve Kerr, M.D., director of the Center for Clinical Management Research at the VAAAHS, professor of internal medicine at the U-M Medical School and a member of the U-M Institute for Healthcare Policy and Innovation.
"We need to move away from a one-size-fits-all performance measure that misses the point of providing appropriate treatment."
Managing cholesterol is especially important for people with type 2 diabetes who often have an increased risk for a heart attack. This is especially true for people age 50 and over.
Physicians commonly aim to lower blood cholesterol for all patients with diabetes to below 100 mg/dl. Recent evidence, however, highlights the importance of individualized treatment for each patient that's not focused on bringing cholesterol levels down to a set value.
In the new study, researchers found that 85 percent of veterans age 50-75 with diabetes treated at the VA received appropriate care, most importantly because they were on at least moderate doses of cholesterol treatment medications called statins. But among patients 18 and older who had no known heart disease, nearly 14 percent may have unnecessarily received high-dose statin medications, putting them at risk of harm from overtreatment.
The research stems from new safety data published this year by the U.S. Food and Drug Administration (FDA) on commonly-used cholesterol-lowering medications known as statins. The FDA issued new guidelines for statin drugs warning users that the medications can cause memory loss, elevated blood sugar levels, and type-2 diabetes, in addition to muscle damage and liver disease.
"The study reveals that we may have both underuse and overuse of statins and should invigorate efforts to make sure that each patient has the opportunity to be treated in a personalized way that is best given their risk profile," says Circulation Editor and Director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation Harlan M. Krumholz, M.D.
Authors says modern healthcare electronic record systems that combine blood pressure, prescription and other health data on individual risks such as heart disease make this method of individualized treatment possible.
The study included more than 960,000 active Veterans Affairs primary care patients 18 years of age or older with type 2 diabetes treated from July 2010 to June 2011.
More information: "Assessing Appropriateness of Lipid Management Among Patients With Diabetes Mellitus: Moving From Target to Treatment"; doi 10.1161/CIRCOUTCOMES.112.966697.
Provided by University of Michigan Health System
- One size doesn't fit all when treating blood pressure in people with diabetes, study suggests May 28, 2012 | not rated yet | 0
- No proof fibrate drugs reduce heart risk in diabetes patients on statins Aug 10, 2011 | not rated yet | 0
- Higher-dose use of certain statins often best for cholesterol issues Oct 15, 2012 | not rated yet | 0
- American Heart Association comment: FDA announces safety changes on labeling for some statins Feb 29, 2012 | not rated yet | 0
- FDA adds new safety information to statin drugs Feb 28, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Change in momentum when a body is thrown up and falls back down.
5 hours ago Say, a body of mass 'm' is thrown at a certain angle with the vertical with certain initial velocity 'u'. The initial momentum of this object is mu....
change in speed and wavelength of light while travelling from one med
5 hours ago what is the mechanism by which light changes its speed and wavelength while travelling from one medium to other. I know it is c/n or lamda/n and know...
Calculus of Variation - Classical Mechanics
8 hours ago I'm reading Classical Mechanics (Taylor), and the 6th chapter is a basic introduction to calculus of variations. I'm super confused :confused: ...
Frictional Force Equation Doesn't Make Sense
8 hours ago Frictional Force is mathematically defined as: Ff = μ*m*g*cos(θ) , where μ is the coefficient of friction, m is the mass of the object, g is...
Calculating Steam Pressure in Closed Container
13 hours ago I am trying to calculate the volume of liquid water i need to place in a sealed container in order to obtain 10 psi of steam pressure in that closed...
Learning curve of Electromagnetism?
19 hours ago I'm taking a first year physics course and have been having a little trouble with the basics of newtons laws and forces and whatnot, though nothing...
- More from Physics Forums - Classical Physics
More news stories
(HealthDay)—Moderate aerobic exercise prevents fructose-induced hypertriglyceridemia in healthy males, according to a study published online May 14 in Diabetes.
Diabetes May 17, 2013 | 5 / 5 (1) | 0 |
A DNA variant near a digestive enzyme does not only affect risk of developing diabetes but also affects the response to treatment, an international consortium of researchers including the University of Dundee has found.
Diabetes May 17, 2013 | not rated yet | 0 |
(Medical Xpress)—Development of a sophisticated artificial pancreas holds potential to transform the lives of patients with Type 1 diabetes.
Diabetes May 16, 2013 | 5 / 5 (1) | 0 |
A small University at Buffalo study has found for the first time that in Type 1 diabetics, insulin injections exert a strong anti-inflammatory effect at the cellular and molecular level, while even small amounts of glucose ...
Diabetes May 16, 2013 | not rated yet | 0
(HealthDay)—Home diabetes regimens partially explain the increased risk of having a hypoglycemia event during hospitalization among older African-American men with diabetes, according to a study published ...
Diabetes May 14, 2013 | not rated yet | 0
The hunt for an HIV vaccine has gobbled up $8 billion in the past decade, and the failure of the most recent efficacy trial has delivered yet another setback to 26 years of efforts.
38 minutes ago | not rated yet | 0
Regular consumption of coffee is associated with a reduced risk of primary sclerosing cholangitis (PSC), an autoimmune liver disease, Mayo Clinic research shows. The findings were being presented at the Digestive Disease ...
8 hours ago | not rated yet | 0 |
Patients with treatment-resistant major depression saw dramatic improvement in their illness after treatment with ketamine, an anesthetic, according to the largest ketamine clinical trial to-date led by researchers from the ...
8 hours ago | 4.5 / 5 (2) | 0 |
Research presented at Digestive Disease Week (DDW) explores new methods for managing digestive health through diet and lifestyle.
8 hours ago | not rated yet | 0
The use of a smartphone application significantly improves patients' preparation for a colonoscopy, according to new research presented today at Digestive Disease Week (DDW). The preparation process, which begins days in ...
7 hours ago | not rated yet | 0
An increasing number of U.S. children are experiencing gastrointestinal issues that require interventions to resolve, according to research presented at Digestive Disease Week (DDW).
22 hours ago | not rated yet | 0 |