Need-to-Know Research on Diabetes, Hypertension, and Retinopathy

OCTOBER 21, 2010
From eye retinopathy, to blood pressure guidelines, this session featured insights from experts in the cardiometabolic medicine field in a panel discussion that included questions from the moderator and the audience.

Christie M. Ballantyne, MD, professor of medicine and chief, Section of Atherosclerosis and Vascular Disease Prevention, at Baylor College of Medicine.
Christopher Cannon, MD, senior investigator, of the TIMI Study Group, Cardiovascular Division at the Brigham and Women’s Hospital.
Robert H. Eckel, MD, director of the Lipid Clinic, University Hospital
Keith Ferdinand, MD, clinical professor, Cardiology Division, at Emory University
Jay S. Skyler, MD, associate director for Academic Programs, at the Diabetes Research Institute.
 
Richard Nesto, MD, was the moderator. Nesto is an associate professor, at Harvard Medical School.

Each presenter discussed a recent clinical trial and FDA updates on a particular field of interest.  Skyler highlighted the ACCORD Eye study, which was a 2x2 factorial design study that included two groups of patients (a lipid study group and a blood pressure group) and within those groups divided the participants into an intensive glucose control group and standard glucose control.

In the lipid trial, it was found that lowering glycemic index through intensive glucose control  effectively reduced eye retinopathy. The lipid group took fenofibrate. The moderator posed the question to the group on whether using fenofibrate for the treatment of retinopathy should be performed? Eckel, on the panel, answered that he believed more trials should be performed on triglyceride lowering drugs before action is taken.

Ferdinand also highlighted the ACCORD trial ,focusing on the blood pressure aspect. The accord trial demonstrated evidence toward a lowering of stroke risks for the blood pressure group with intensive glucose control. The study focused on lowering blood pressure to normal levels for the participants. Ferdinand’s discussion centered on whether the guidelines that set 130/80 as the target for diabetics should be changed to aim for lower numbers. Ferdinand said he had some reservations about changing the guidelines, mainly in that if they were changed too quickly it may confuse practicing physicians  and create inconsistencies in treatment.

An audience member posed the question of whether or not it would be a good idea to possibly divide diabetic patients into two groups, one of the groups containing members that had the condition for more than 10 years and were over age 65. He suggested that the target aim for this group would be to present with a blood pressure of 140/80 and an HbA1C of 8. Ferdinand agreed that it may be one possible effective way of doing this, but still requires more research.

The moderator questioned the panel on a common issue that occurs in cardiovascular offices across the country: what to do when a patient’s blood pressure is taken and reveals a high reading, but the patient insists that at home the blood pressure is normal? Ballantyne responded by saying that many times these patients are under stress which can affect the readings.

Eckel spoke about obesity and highlighted the Look AHEAD trial which assessed long-term intense four-year program for diabetic overweight or obese patients. It involved an intense exercise and physical activity froup and an education group. The four-year data demonstrates that p values were very strong. The intense workout group demonstrated the most pronounced effect on HDL. While the LDL cholesterol levels went down more in the education group, mainly because of the diet improvements.

Eckel added, in conclusion, that it’s important for physicians to remember there are biological reasons why weight is maintained and that physicians should be sure not to forget.

“We’ve got to prevent obesity to begin with,” he said. “It’s a tough sell. It’s not a simple send the patient to a dietician and get the job done.”

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