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Wednesday, 19 December 2012
Patients with diabetes may not receive best treatment to lower heart disease risk !
18, 2012 in Diabetes
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.
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.
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.
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.
need to move away from a one-size-fits-all performance measure that misses the
point of providing appropriate treatment."
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
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.
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.
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.
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.
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.