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Early intensive multifactorial therapy reduces stroke risk

Visual impairment linked to mortality in diabetes

Investigators were aware that visual acuity loss is a common consequence of type 2 diabetes and may complicate diabetes self-management. They investigated patients with newly-diagnosed type 2 diabetes to assess whether loss of visual acuity was an independent risk factor for mortality in this population. They found that impaired visual acuity at diagnosis was associated with increased all-cause mortality, independent of other risk factors for mortality.

Variability in HbA1c associated with adverse outcomes

Investigators wanted to examine whether variation in HbA_1c, the degree of variability and how HbA_1c varies over time predict hospitalisation and mortality in individuals with type 2 diabetes. They performed a retrospective analysis of a large cohort of patients from UK primary care and found that HbA_1c variability was strongly associated with overall mortality and emergency hospitalisation. This was not explained by average HbA_1c or hypoglycaemic episodes. Findings were similar for emergency hospitalisations; however, increasing average HbA_1c rather than variability was predictive of emergency hospitalisation for coronary artery disease and ischaemic stroke. Investigators suggest that clinical targets should focus on both the stability and absolute level of HbA_1c.

Diabetes Distilled: Blood pressure variability linked to cardiovascular outcomes in diabetes

Increased risk of major cardiovascular events predicted by long-term systolic blood pressure variability.

Poor pregnancy outcomes still high in diabetes

Neonatal death, stillbirth, congenital anomaly, large and small for dates babies and neonatal unit admission in diabetic pregnancies remain very high when compared to non-diabetic pregnancies. According to the latest National Pregnancy in Diabetes Audit, women with diabetes are not adequately prepared for pregnancy, with almost 90% not receiving risk-reducing pregnancy preparation as recommended by the National Institute for Health and Care Excellence. These findings have remained unchanged over the past 5 years.

Blood pressure variability linked to CV outcomes in diabetes

Blood pressure variability (BPV) is considered a novel risk factor for cardiovascular disease, as clinical trials have confirmed that short- and long-term variations in blood pressure independently contribute to target organ damage, cardiovascular events and mortality. In this systematic review and meta-analysis, investigators examined the relationship between BPV and all-cause mortality, major adverse cardiovascular events, microvascular complications and organ damage in type 2 diabetes. They found that in adults with type 2 diabetes, systolic BPV was associated with adverse outcomes and concluded that variation in blood pressure provided information beyond mean blood pressure on the risk of cardiovascular disease in these individuals.

Time-in-range an increasingly important metric

Normalised glucose levels in type 1 diabetes a way off

Tandem system significantly increases time-in-range in young people

Renoprotection for patients with diabetes and kidney disease

Canagliflozin is cardioprotective in diabetic kidney disease

Semaglutide reduces cardiovascular risk in type 2 diabetes

Lowering LDL-cholesterol reduces CV event risk in diabetic dyslipidaemia

Hypoglycaemia increases risk of adverse events in older patients with dementia

Diabetes Distilled: Behavioural change lowers 10-year cardiovascular and mortality risk

Small changes after a recent diabetes diagnosis reduce cardiovascular and mortality risks.

Diabetes Distilled: Intensive intervention reduces stroke risk in diabetes with microalbuminuria

Steno-2 reveals that treating multiple risk factors reduces cerebrovascular events.

Behavioural change lowers 10-year cardiovascular and mortality risk

Adults with screen-detected type 2 diabetes, recruited from general practices in Eastern England, were assessed for changes in diet, physical activity and alcohol use in the year following a diabetes diagnosis. They were then followed up for an average of 10 years. Investigators found that, in the year following a diabetes diagnosis, small reductions in alcohol consumption were correlated with a lower hazard of cardiovascular disease and small reductions in calorie intake were associated with a lower hazard of all-cause mortality.

Intensive intervention reduces stroke risk in diabetes with microalbuminuria

Data from the Steno-2 Study were analysed to assess whether multiple risk factor intervention reduced the chance of stroke in individuals with type 2 diabetes and microalbuminuria. Participants were randomly allocated to intensified or conventional multifactorial intervention targeting classical cardiovascular disease risk factors. Post hoc analysis showed that the risk of stroke and number of recurrent cerebrovascular events were reduced with intensified multiple risk factor intervention in patients with type 2 diabetes and microalbuminuria.

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