Diabetes and CVD

CVD diabetes supplement programme

This learning programme is based on the BJC supplement ‘Management of cardiovascular disease in the patient with diabetes’ in which we learn about reducing the risks of cardiovascular disease in patients with type 2 diabetes, and which groups are most at risk.

It is estimated that over four million people in the UK live with type 2 diabetes with many more undiagnosed. The condition imposes considerable premature vascular risk on individuals, with relative risks varying by age of diagnosis and ethnicity, with South Asians being at higher risk compared to white Europeans in the UK.

This programme describes and reviews:

  • – these risks in all patients highlighting the higher risk in younger-onset type 2 diabetes and South Asian populations
  • – the management of cardiovascular risk in type 2 diabetes, including optimising cardiovascular risk
  • – the use of older and new diabetes drugs
  • – optimising cardiovascular risk in diabetes including diet, blood pressure control and lipid modification, and other secondary prevention interventions.

Each module has a series of multiple-choice questions. Its two hours of learning lead to two continuing professional development (CPD) credits.

The programme has been made available with an unsolicited arms-length educational grant from Astra Zeneca. It has been independently written by six experts in the field.

Contributors

Supplement editor Naveed Sattar, Professor of Metabolic Medicine and Honorary Consultant, Institute of Cardiovascular and Medical Sciences, University of Glasgow
Ramzi A Ajjan, Associate Professor and Consultant in Diabetes and Endocrinology, The LIGHT Laboratories, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds
Wasim Hanif, Professor Diabetes and Endocrinology, Consultant Physician and Head of Service Diabetes, University Hospitals Birmingham
Sam M Pearson, Specialist Registrar in Diabetes and Endocrinology, St James’s University Hospital, Leeds
Radhika Susarla, Research Scientist (Diabetes), University Hospitals Birmingham NHS Foundation Trust
W David Strain, Clinical Senior Lecturer and Honorary Consultant
University of Exeter Medical School, Institute of Biomedical and Clinical Science, Department of Diabetes and Vascular Research, Royal Devon & Exeter Hospital

Diabetes and CVD module 1: The cardiovascular profile in diabetes

Released 20 September 2018   Programme: Diabetes and CVD 0.5 CPD/CME credit, 0.5 hours

Diabetes and CVD module 1: The cardiovascular profile in diabetes
  • Risk of a range of vascular outcomes, e.g. myocardial infarction, stroke etc., is approximately doubled in patients with diabetes
  • Relative risks may vary by age of onset of diabetes
  • Aggressive management is warranted in these groups and there is a need for a greater focus on abnormal fluid volume shifts

Diabetes and CVD module 2: Diabetes and cardiovascular risk in UK South Asians – an overview

Released 20 September 2018   Programme: Diabetes and CVD 0.5 CPD/CME credit, 0.5 hours

Diabetes and CVD module 2: Diabetes and cardiovascular risk  in UK South Asians – an overview
  • Prevalence of diabetes is high in people with South Asian heritage, along with an increased risk of complications (coronary heart disease, diabetic retinopathy and end-stage renal disease) occurring at younger age with lower duration of diabetes
  • Diabetes occurs at a lower body mass index (BMI) in this group due to altered body composition, meaning South Asians should be encouraged to maintain lower BMIs lifelong and to keep as active as possible
  • Younger patients with diabetes should be managed aggressively to reduce their risk of developing complications linked, in particular, to hyperglycaemia

Diabetes and CVD module 3: Drugs for diabetes – the cardiovascular evidence base

Released 20 September 2018   Programme: Diabetes and CVD 0.5 CPD/CME credit, 0.5 hours

Diabetes and CVD module 3: Drugs for diabetes – the cardiovascular evidence base
  • Cardiovascular (CV) randomised-controlled trials (RCTs) with newer hypoglycaemic agents have helped to guide therapies in diabetes. Agents in the dipeptidyl-peptidase family are CV neutral with some glucagon-like peptide (GLP) analogues showing vascular protection. Agents in the sodium-glucose co-transporter (SGLT) family have shown CV protection with the added benefit of reducing heart failure risk and potential favourable renal effects
  • Data from one RCT should not be generalised to other members of the class, and each agent requires separate assessment
  • The widespread belief that metformin is CV protective is, in our opinion, not based on robust evidence, although current knowledge suggests this agent is at worst CV neutral. In contrast, agents in the sulfonylurea group have been associated with increased CV risk, although conclusive large-scale CV outcome trials are currently lacking
  • There is inconsistency in the quality of CV risk assessment comparing older and newer hypoglycaemic agents, which should be taken into account when drawing up guidelines and making treatment recommendations. Some recent guidelines have taken newer trial data into account when making recommendations for those with diabetes and CV disease

Diabetes and CVD module 4: Optimising cardiovascular risk reduction in diabetes

Released 20 September 2018   Programme: Diabetes and CVD 0.5 CPD/CME credit, 0.5 hours

Diabetes and CVD module 4: Optimising cardiovascular risk reduction in diabetes
  • Although good glycaemic control in diabetes remains the optimal way to reduce microvascular complications, cardiovascular risk reduction is a priority in the management of type 2 diabetes
  • Lifestyle intervention may not provide cardiovascular (CV) benefit in those with diabetes, although, as it improves overall wellbeing, it should still be advocated
  • Good blood pressure control, however achieved, is essential
  • People with diabetes should receive a statin unless there is a compelling reason not to
  • If cholesterol targets are not achieved on statin alone, or a patient is intolerant, ezetimibe may provide additional benefit in those with diabetes and previous CV event
  • There is no role in primary prevention for antithrombotics, although aspirin and/or clopidogrel should be used in secondary prevention
  • Newer biological agents may have a role in the very high risk, however, the cost-effectiveness of such strategies has not been evaluated