Tuesday, 23 April 2013

Invasive strategy for non-ST elevation ACS in diabetes

A meta-analysis of trials that included a total of nearly 10,000 patients looked at the risk reduction for invasive cardiovascular intervention versus conservative approaches in people with diabetes presenting with non-ST segment elevation acute coronary syndromes.

The group well-regarded TIMI group found that:

"An early invasive strategy yielded similar RR reductions in overall cardiovascular events in diabetic and nondiabetic patients. However, an invasive strategy appeared to reduce recurrent nonfatal MI to a greater extent in diabetic patients. These data support the updated guidelines that recommend an invasive strategy for patients with diabetes mellitus and non-ST-segment elevation acute coronary syndromes." [1]

The absolute risk reduction of non-fatal MI is given in the paper as 3.7% which would mean (I calculate) that 28 people would have to undergo invasive cardiovascular intervention (angioplasty / coronary artery bypass graft) to prevent one non-fatal MI and its consequent risks of heart failure and shortened life-expectancy.

1. O’Donoghue ML, Vaidya A, Afsal R, Alfredsson J, Boden WE, Braunwald E, Cannon CP, Clayton TC, de Winter RJ, Fox KAA, Lagerqvist B, McCullough PA, Murphy SA, Spacek R, Swahn E, Windhausen F, Sabatine MS. An invasive or conservative strategy in patients with diabetes mellitus and non-ST-segment elevation acute coronary syndromes: a collaborative meta-analysis of randomized trials. J. Am. Coll. Cardiol. 2012 Jul;60(2):106–111. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22766336

Type 2 Diabetes in the young

Just blogged about one of our course director's talks at the BMJ / University of Leicester Diabetes Diploma course this weekend.

Professor Melanie Davies talked about the alarming issue of Type 2 Diabetes in the young and how they present with dangerous complications of diabetes.