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More Frequent Monitoring Advised for People with Diabetes
More Frequent Monitoring Advised for People with Diabetes -- Posted by Gumbo on 10-31-04 05:12
More Frequent Monitoring Advised for People with Diabetes
More Frequent Monitoring Advised for People with Diabetes
Source: Johns Hopkins Medical Institutions
NEWSWISE Medical News, 20-Sep-2004 --
A Johns Hopkins study suggests that people with type I and type II diabetes
would be well advised to monitor their blood sugar levels more than the
usual twice daily to make sure that levels are not elevated over 150
milligrams per deciliter for sustained periods. A research team at Hopkins
has added new and detailed evidence of the link between elevated blood sugar
levels in people with diabetes and increased risk of developing
life-threatening forms of cardiovascular disease - including coronary heart
disease, stroke and peripheral artery disease.
Their findings, part of a broad retrospective meta-analysis to be published
in the Annals of Internal Medicine online Sept. 21, suggest monitoring
long-term blood sugar control by level of glycated hemoglobin (also called
glycosylated hemoglobin) and adding this measurement to regular monitoring
of cholesterol levels and blood pressure.
"The relationship between blood sugar levels - or glycemic control - in
people with diabetes and whether this increases their risk of developing
heart disease has remained unclear until now, despite many different studies
about specific types of cardiovascular problems," said the study's senior
author, endocrinologist Sherita Golden, M.D., M.H.S., assistant professor of
medicine and epidemiology, at The Johns Hopkins University School of
Medicine and Bloomberg School of Public Health.
"People living with diabetes are twice as likely to die from cardiovascular
disease compared to those without diabetes. As a result, many people living
with diabetes monitor their health for well-known risk factors for heart
disease, such as obesity, cholesterol levels and blood pressure - but, the
big unknown has been the role of blood sugar levels in managing their risk
of developing cardiovascular disease."
After pooling and re-analyzing the data from 13 previously published
studies - involving nearly 10,000 people from North America and Europe with
type I or type II diabetes - the researchers concluded that for every 1
percent rise in glycated hemoglobin levels, there was an 18 percent increase
in the risk of developing large-vessel cardiovascular disease among people
with type II diabetes.
For people with juvenile onset or type I diabetes, the researchers found a
similar increased risk of 15 percent for every one percent rise in levels of
glycated hemoglobin; however, as there were fewer studies involving people
with type I diabetes, this risk estimate is not as reliable as the estimate
for type II.
A landmark British study in 1998, the United Kingdom Prospective Diabetes
Study (UKPDS), first nailed down the direct link between control of blood
sugar levels in people with type II diabetes and risk of developing
small-vessel disease, where excessive levels of blood sugar can have serious
long-term consequences, including blindness, kidney damage and peripheral
nerve disease. However, this study was largely considered inconclusive by
the medical community because it lacked statistically significant results,
and despite results that showed a 16 percent decrease in large-vessel
cardiovascular disease in people whose blood sugar levels were aggressively
treated. Hence, the U.K. study did not fully clarify the need for or
frequency of monitoring for prevention of large-vessel disease.
The monitoring of glycated hemoglobin is a longer-term measure of blood
sugar control, reflecting a three-month average of blood sugar levels. This
contrasts with the more commonly known measurement of milligrams per
deciliter, which reflects daily blood sugar levels, and is used by people
with diabetes, who often carry finger-prick devices to check their blood
glucose levels throughout the day. The current desired range for daily
control of blood sugar levels is 80 to 120 mg/dL, prior to meals.
"Our research suggests that management of blood sugar levels is still a key
part of cardiovascular disease prevention in diabetes," said Golden. "It
will be challenging for patients to achieve tight glycemic control (of 7%
HbA1c, or less, approximately 150 mg/dL on a daily basis). However, we now
have more information to counsel and motivate patients to better self care.
In people with diabetes, particularly type II, we must consider monitoring
and aggressively treating all three risk factors for heart disease:
cholesterol, blood pressure and blood sugar levels. People with type II
diabetes want to avoid any prolonged periods when their blood sugar levels
exceed 150 mg/dL."
During the 18-month study, the Hopkins team carefully evaluated 694
published articles that looked at glycated hemoglobin as a measure of
glycemic control and cardiovascular disease. Of these, 69 articles were
selected for thorough review of methodology and data to determine which data
sets should and could be pooled for group analysis. In the end, 13 studies
were selected: Three looked at type I diabetes, and 10 involved type II
diabetes. Among the major studies pooled into the larger analysis were
results from the 1998 UKPDS and the 1999 Wisconsin Epidemiology Study of
Diabetic Retinopathy, another long-term study of patients.
According to the latest statistics from the International Diabetes
Federation, in 2001, more than 13 million Americans live with type II
diabetes. Type II diabetes is more common in African, Hispanic and Native
Americans than in Caucasians.
This study was funded by the national Agency for Healthcare Research and
Quality and with grants from the National Institutes of Health. Further
assistance was provided from the Robert Wood Johnson Foundation's Harold
Amos Minority Medical Faculty Development Program.
Other investigators in this research, conducted solely at Johns Hopkins
Evidence-Based Practice Center and Bloomberg School of Public Health, were
lead author Elizabeth Selvin, M.P.H., Spyridon Marinopoulous, M.D., M.B.A.;
Gail Berkenbilt, M.D., Ph.D.; Tejal Rami, M.P.H.; Frederick Brancati, M.D.,
M.H.S.; and Neil Powe, M.D., M.P.H., M.B.A.
A targeted newswire featuring breaking medical news stories from over 200
leading academic and research institutions including: Johns Hopkins,
Stanford, Harvard, and the Mayo Clinic.
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