Blood pressure, lipids and glucose in type 2 diabetes: how low should we go? Re-discovering personalized care

Epidemiological studies have clearly shown a direct relationship between the levels of blood pressure, glycaemia and LDL-cholesterol, and the complications of diabetes. Although 'lower should be better', the results of recent clinical trials examining the benefits of normalizing risk facto...

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Bibliographic Details
Published in:	European heart journal 2011-09, Vol.32 (18), p.2247-2255
Main Authors:	Rutter, Martin K, Nesto, Richard W
Format:	Article
Language:	eng
Subjects:	Atherosclerosis (general aspects, experimental research) Biological and medical sciences Blood and lymphatic vessels Blood Glucose - metabolism Blood Pressure - physiology Cardiology. Vascular system Cholesterol, LDL - metabolism Clinical Trials as Topic Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - physiopathology Diabetes Mellitus, Type 2 - prevention & control Diabetes. Impaired glucose tolerance Diabetic Angiopathies - blood Diabetic Angiopathies - physiopathology Diabetic Angiopathies - prevention & control Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Fibric Acids - therapeutic use Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Hypercholesterolemia - prevention & control Hypertension - prevention & control Hypoglycemia - prevention & control Hypoglycemic Agents - therapeutic use Hypolipidemic Agents - therapeutic use Lipids Medical sciences Practice Guidelines as Topic Precision Medicine Risk Factors
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Summary:	Epidemiological studies have clearly shown a direct relationship between the levels of blood pressure, glycaemia and LDL-cholesterol, and the complications of diabetes. Although 'lower should be better', the results of recent clinical trials examining the benefits of normalizing risk factor levels have been counter-intuitive and, at times, disturbing, and have called into question this notion. This review focuses on patients with type 2 diabetes who make up 90% of patients with diabetes. It aims to provide a clear summary and interpretation of recent trials to help clinicians to set targets for cardiovascular risk factors in individual patients. It highlights areas of agreement and disagreement between current guidelines. Recent data indicate that some patient subgroups might respond differently to aggressive risk factor management. Our challenge is how to identify these patients and deliver truly personalized diabetes care that maximizes benefit, and minimizes harm. Guidelines and position statements stress the value of setting personalized targets. We explore what this means, and how this might be achieved in practice by outlining some solutions to issues that currently limit the delivery of personalized care. We call for further research assessing the overall clinical impact of cardiovascular risk factor intervention by finding appropriate ways of combining data on mortality, complications, side-effects, quality of life, and cost-effectiveness.
ISSN:	0195-668X 1522-9645