New ways to fight type 2 diabetes

Apr 19 2004

Adults with type 2 diabetes who have just one additional risk factor for heart disease should be taking medication to lower cholesterol levels, according to new guidelines from the American College of Physicians (ACP).

Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use sugar. Sugar is the basic fuel for the cells in the body, and insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems:

• Right away, your cells may be starved for energy.

• Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart.

While diabetes occurs in people of all ages and races, some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population.

Dr. Vincenza Snow and members of the Clinical Efficacy Assessment Subcommittee of the ACP based their recommendations, reported in the Annals of Internal Medicine, on the results of 12 lipid-lowering studies that contained information about outcomes for people with diabetes.

Pooled data from the 12 studies indicated that so-called statin drugs (e.g., Lipitor, Zocor or Crestor), along with another lipid-lowering agent gemfibrozil, lead to a greater than 20 percent reduction in major heart-related events in patients with diabetes.

Snow, of the ACP in Philadelphia, and her team recommend lipid-lowering therapy for all patients with diabetes and known coronary disease. Such treatment is also advised for patients with any significant risk factor for heart disease, including age older than 55 years, high blood pressure, smoking, enlargement of the left ventricle of the heart, previous stroke, and peripheral arterial disease.

The only patients with diabetes for whom these drugs seemed to provide little benefit were those with no risk factors for cardiovascular disease.