“The large target trials (ACCORD, ADVANCE and VADT) have made us cautious of pushing patients too hard. Those trials showed us that no one HbA1c target fits everyone with diabetes,” Dr. Ali told Endocrinology Advisor.
“The specifics regarding what targets are appropriate for young people with diabetes are appreciated and clear. Targeting 7.5% instead of 8.5% is also meaningful, as one percentage point reductions in HbA1c in the DCCT and UKPDS trials were associated with clinically significant reductions in incidence of macrovascular and microvascular diabetes complications.”
He said the changes involving statin therapy may help improve outcomes because they are not based on a one-size-fits-all approach.
“Statins have been shown to have cholesterol-lowering and microvascular disease-lowering benefits in many trials and meta-analyses. There are also at least two studies where individuals with low levels of LDL cholesterol still benefited from statin use,” said Dr. Ali.
He said what is not yet clear is whether moderate- or high-intensity statins are better for the different groups proposed by the ACC/AHA guidelines and whether there are more or fewer side effects experienced with each. Dr. Ali said both of these issues should become more apparent in time and with more evidence. Current knowledge suggests that benefits may outweigh risks.
Diabetes researcher Tim Holt, MD, who is with Nuffield Department of Primary Care Health Sciences at University of Oxford in the United Kingdom, agrees. He believes the change in lipid management should lead to improved outcomes because they are more personalized. The U.K. has already adopted a similar approach and it appears to be appropriate, he said.
“As in the U.K., the decision over whether to treat is based on CVD risk and not on the actual cholesterol level itself. Overall, the likely result will be that more people will take statins, many at higher doses if the guidelines are followed. Provided this treatment is tolerated, it is likely to be beneficial,” Dr. Holt told Endocrinology Advisor.