Effects of Glucose Monitoring, Essay Example

Effects of Glucose Monitoring on Cardiovascular Outcomes in Veterans with Type-2 Diabetes

Cardiovascular disease is a leading cause of death and complications in type-2 diabetic patients. Over 60% of patients afflicted with type-2 diabetes succumb to cardiovascular disease with a higher percentage resulting in serious complications. The prevalence of hypertension, vascular disease, dyslipidemia, as well as other abnormalities is alarming with the consequences of these abnormalities presenting a burden to patients and society as a whole (Fox CS, Coady S, Sorlie PD, et al, 2007, p. 1544-1550).

Development of this disease which leads to complications is preventable through interventions such as lifestyle changes, antiplatelet therapy, and management of lipids and blood pressure.  The problem, which remains unresolved, is whether the control of glucose independently minimizes cardiovascular complications in type-2 diabetes patient in advanced stages of the disease. Patients with advanced type-2 diabetes, the issues remain whether glucose control will independently reduce cardiovascular difficulties.  Cross-sectional studies, population surveys and short-term intervention trials have all produced mixed results in an attempt to answer the questions. This study, along with ACCORD and the ADVANCE studies examines different populations using diverse approaches; arriving at a similar conclusion.

The selection criteria for patients included in this study include an inadequate response to maximal doses of insulin therapy or an oral agent. Patients with a glycated haemoglobin level of less than 7.5%, who have had a cardiovascular event during the previous 6 months, meet the criteria. Advanced severe angina, congestive heart failure, and a poor prognosis with a life expectancy of less than seven years also qualify a participant. A participant criteria also includes greater than 40 body-mass index, a serum creatinine level greater than1.6 mg per deciliter with levels greater than three times the upper limit within the normal range of alanine amino-transferase (Abraira C, Duckworth W, McCarren M, et al, 2003, p. 314-322).

Results of this study reveal patients with a prior diagnosis of type-2 diabetes with intensive glucose control did not minimize cardiovascular event occurrences. In the three studies, baseline glycated haemoglobin levels were 9.4%, ^and 8.1% in the ACCORD study, with 7.2% in ADVANCE study. After intensive therapy, glycated haemoglobin levels changed to 6.9% in the research and 6.4% in the ADVANCE and ACCORD studies and to 8.4%, 7.0% and 7.5% respectively following standard therapy.   Therefore, the studies as a whole fail to demonstrate a decrease in cardiovascular events. The rates of weight gain and hypoglycaemia were higher in the group undergoing intensive-therapy in all three trials. They were minimally affected by intensive control of glucose with no significant differences in substantial nephropathy, or neuropathy and retinotherapy seen. There was a notable reduction (P = 0.01) in any worsening of albumin excretion observed in the group undergoing intensive therapy and progression to macroalbuminuria also remarkable (P = 0.04%).

The results of this as well as other studies indicate that intensive glucose control did not reduce the prevalence of cardiovascular complications. Additionally it appears that intensive glucose control had minimal effects on solid micro vascular complications like decreased GFR, severe renal changes and vitrectomy in a period of five to six years. However, intensive glycaemia control earlier in the course of the disease may have some benefit, particularly if severe hypoglycaemia can be avoided.  Currently proper management of dyslipidemia and hypertension as well as other cardiovascular risk factors are the most effective approach to curb cardiovascular morbidity and mortality. Factors including the levels of HDL cholesterol, systolic blood pressure, weight gain and pharmacologic agents could contribute to the recorded lack of benefits associated with intensive glucose control. Further detailed studies should be conducted for further determinations. These are the likely targets for future studies on issues around diabetes and cardiovascular outcomes.

Observing ethical issues during human research is a requirement as demonstrated by the researchers conducting these studies. Consent forms protocol issues were appropriately completed and approved by the institutional review board for all 20 participating sites and each patient. Ethically this study poses the argument on the validity of denying non-participating patients the current proven therapies making them act as a control in the study. The studies need to be carried out with due care to avoid such issues.

Works cited

Abraira C, Duckworth W, McCarren M, et al. Design of the cooperative study on glycemic control and complication in diabetes mellitus type-2: Veterans Affairs Diabetes Trial. J Diabetes Complications 2003; 7:314-322.

Fox CS, Coady S, Sorlie PD, et al. Increasing Cardiovascular Disease Burden due to diabetes mellitus: the Framingham Heart Study. Circulation 2007; 115:1544-1550

William D., Carlos A. et.al., Glucose Control and Vascular Complications in Veterans with Type-2 Diabetes. N Engl J Med 2009; 360:129-139