By Allan Mai ‘20

There are currently 415 million people worldwide living with diabetes; this number is expected to rise to 640 million by the year 2040. Complications, especially coronary artery disease (CAD), is one of the leading causes of death in diabetic patients; conversely, optimizing management of such complications can also significantly increase lifespan. While the previous assumption was that good glycemic control would automatically lower the risks of a vascular diseases associated with diabetes, trials have shown that patients with optimal glycemic control can still suffer from strokes and the effects of CAD. A recent study conducted at the National Center for Global Health and Medicine in Japan by researchers Tetsuro Tsujimoto and Hiroshi Kajio sought to evaluate the association between cardiac treatment strategy and cardiac event risk in type 2 diabetic patients with CAD based on a history of myocardial infarction.

The study was performed using data from a previous trial known as BARI 2D, which included 2,300 patients with type 2 diabetes and CAD. The BARI 2D trial used a 2×2 factorial design, which efficiently tests two interventions in one sample: the first intervention was early revascularization (restoration of blood flow through surgery) combined with intensive medical therapy, and the second was intensive medical therapy alone while supplementing endogenous and exogenous insulin. The overall results suggested that in patients who had not previously suffered a myocardial infarction, the risk of a major cardiac event between patients who were treated by revascularization and those who underwent the intensive therapies was not significantly different. In patients with a history of myocardial infarction, however, the chances of a major cardiac event were much higher in the revascularization group than in the intensive medical therapy group.

This study is only one of the many ongoing studies examining optimal treatment paths for diabetic patients. Other studies have focused on differing areas of treatment. For example, one study compared the different revascularization treatment options (coronary artery bypass versus percutaneous coronary intervention) and their effects on patients. The researchers hope that the combined results of these studies will yield new insights for clinical application in the treatment of coronary disease in diabetics.
References

1. T. Tsujimoto and H. Kajio, Optimal cardiac strategy based on the history of myocardial infarction in type 2 diabetic patients with coronary artery disease. Scientific Reports 9, (2019). doi: 10.1038/s41598-019-39857-0.
   
2. Image retrieved from: https://www.pexels.com/photo/adult-doctor-girl-healthcare-355934/