Endocrine Abstracts

The UKPDS study has shown that, intensive lowering of blood sugar and blood pressure decreases the risk of micro vascular complications in individuals with type 2 diabetes. The Steno-2 study has shown that target driven, long-term intensive treatment in patients with type 2 diabetes and microalbuminuria reduces the risk of cardiovascular and micro vascular events by about 50%.

We investigated the effect on the 10 years absolute CHD risk of our type 2 diabetic patients with microalbuminuria of achieving the following goals: smoking cessation, HbA1c (<7%), systolic blood pressure (130 mmHg) and total cholesterol (<4 mol/l).

Methods: About 1331 patients with type 2 diabetes were screened from January 2004 to March 2006. 181 (13.6%) of them were found to have microalbuminuria based on their early morning urine albumin/creatinine ratio (2.6–25 in men and 3.6–35 in women).

The 10-year cardiovascular risk profile of these patients was estimated both at baseline and after correction to the indicated target thresholds, by using the UKPDS risk engine. This data was compared with the risk profile of a group of randomly selected patients without microalbuminuria.

Results: Our patients were older than those in both the Steno study groups (62 vs 55 years), they had shorter duration of diabetes (1.3 vs 5.5 and 6 years), lower HbA1c (7 vs 8.8 and 8.4%), lower systolic blood pressure (143 vs 149 and 146 mmHg) and lower total cholesterol (4.6 vs 5.8 and 5.4 mmol/l). Twenty percent of our patients were current smokers as compared to 34 and 40% in the Steno groups.

By lowering HbA1c to <7%, total cholesterol to <4 mmol/l and systolic blood pressure to 130 mmHg, the absolute 10 years risk of coronary heart disease in our patients decreased from 21.1 to 14%.