CLINICAL
NEWS
American College of Cardiology Extended Learning
The Glucose Paradox and Management of Patients with
Type 2 Diabetes
Y
events. So, is there any place for tight glucose
eah, yeah: diabetes is not your departDIABETES: RISK MULTIPLIER
control? Probably.
ment. Yet, as last month’s CSWN cover
Recently, Dr. Creager and colleagues published a
story less than subtly suggested, there are
pair of papers on diabetes and vascular disease.4,5
some basics about diabetes that
cardiologists should familiarize
themselves with in order to care
for this growing population of
patients.
We’ve known, since the last
century, of the strong association between glycemia and the
macrovascular and microvascular
complications of type 2 diabetes
mellitus (T2DM). Mark A. Creager, MD, a Professor of Medicine
®
at Harvard, has published on the
epidemiology, pathophysiology,
and management of diabetes and
atherosclerosis.1 T2DM markedly
increases the risk of MI, stroke,
NATIONAL COVERAGE FOR EFFIENT*
amputation, and death. The metabolic abnormalities caused by
diabetes induce vascular dysfuncCommercial†
Medicare Part D‡
tion that predisposes diabetics to
atherosclerosis.
*Access defined as unrestricted lowest brand co-pay (LBC) or 2nd LBC.
Thus, tight glucose control
Approximately 73%† of commercial and 80%‡ of
should reduce risk. That sugMedicare Part D patients have unrestricted access
gests the inclusion of glycemic
to Effient at the LBC amount or better
measures in algorithms used to
predict the risk of CV disease
(CVD) might improve their
predictive ability. Indeed, the
2010 ACC/AHA guidelines on
risk assessment concluded that
measurement of HbA1c levels
may be reasonable in asymptomatic adults without a diagnosis
of diabetes.2 Makes sense, but it
isn’t true. It turns out that HbA1c
is not associated with clinically
meaningful improvement in assessment of CVD risk. That was
a big surprise when the results
were first reported of an analysis
of data from almost 300,000
people without known diabetes
and CVD at baseline indicates.3
There seems to be a glucose
paradox: while fasting blood
sugar and HbA1c predict future
macro- and microvascular events,
tight glucose control definitely
reduces microvascular events but
does not impact macrovascular
effects. That’s quite different from
blood pressure control and the
Source: Managed Markets Insight & Technology (MMIT), LLC as of June 2015, and is subject to change
use of statins for lipid lowering,
without notice by a health plan or state. Please contact the plan or state for the most current information
which both reduce macrovascular
This information is not a guarantee of coverage or payment (partial or full). Actual benefits are determined
UNRESTRICTED COMMERCIAL AND
MEDICARE PART D FORMULARY
COVERAGE NATIONWIDE
FOR YOUR PATIENTS ON EFFIENT (PRASUGREL)
90 + 88
%
%
by each plan administrator in accordance with its respective policy and procedures
24
CardioSource WorldNews
Formulary information in this document does not establish clinical comparability of products and should
not be seen as making any claim regarding efficacy or safety