Endocrine Abstracts

The number of people world wide with diabetes is predicted to double to 221 million by the year 2010. Diabetes remains the leading cause of blindness, end stage renal disease and lower extremity amputations in the United States but the greatest impact of the disease is the two to four times greater risk of coronary heart disease (CHD) and stroke. Of the 5102 patients, aged 25 to 65 years with newly diagnosed type 2 diabetes recruited into the UK Prospective Diabetes Study (UKPDS), 59% of all deaths were from cardiovascular disease. Epidemiological analysis of information at diagnosis showed that, after adjustment for age and sex, potentially modifiable independent CHD risk factors were a raised LDL cholesterol, a low HDL cholesterol, hyperglycaemia, hypertension, smoking and an elevated homocysteine. The UKPDS demonstrated that improving glycaemic control by 0.9% HbA1c with sulphonylurea or insulin therapy reduced the risk of any diabetes-related endpoint by 12% (p=0.029) with a 16% trend to a reduced risk of myocardial infarction (p=0.052). There was no evidence that sulphonylurea or insulin therapies were harmful as no increase was observed with these agents in the incidence of cardiovascular deaths, myocardial infarction or sudden death. In those overweight patients allocated to metformin the risk of myocardial infarction was reduced by 39% (p=0.010). Improving blood pressure control in hypertensive patients with diabetes by 10/4 mm Hg reduced deaths related to diabetes by 32% (p=0.019). The Heart Protection Study showed that a 0.96 mmol/L reduction in LDL cholesterol reduced CHD risk reduction in patients, including over 5000 with diabetes, by 24%. The UKPDS Risk Engine, a newly developed mathematical model provides diabetes specific estimates of CHD and stroke risk that may replace the Framingham equations in helping to plan the optimal management strategy for people with type 2 diabetes.