Episode 56 continues from where we left off last time with type 2 diabetes. In this podcast, we bring out the numbers and put the risks of diabetes into context by discussing the absolute cardiovascular risks associated with different levels of HbA1c. In addition, we talk about other things to look at in the evaluation of type 2 diabetes and Jillian Popel again joins us for the ride. She is quite shocked by what she hears about how “absolutely low” the renal risks associated with type 2 diabetics really are. She is also quite shocked by most of what Mike and James have to say in general, but that’s a whole other issue for another time.

Show Notes

1) Diabetes is NOT a CHD risk equivalent

Diabet Med 2009;26:142–8

2) Calculating cardiovascular risk for type 2 diabetics<

UKPDS risk engine

3) The risks associated with diabetes

Diabetes Care 2003;26:2353-8

Episode 55 starts off a “sweet” new topic – type 2 diabetes. In the first podcast on this topic we talk about the whole issue of the diagnosis of diabetes, how to make the diagnosis and to some degree what the diagnosis means.

Episode 54 finishes off the whole issue of CRP measurement by looking at the evidence we have about what happens to patients when they take drugs that lower CRP – glitazones, COX-2s, fibrates, vitamin E, niacin, ezetimibe, and statins. Other than statins and maybe niacin, it doesn’t look good – in contrast to Mike and James of course that is.

Show Notes

1) Drugs that lower CRP

Cardiovasc Drug Rev 2006;24:33-50

Chest 2004;125:1610-5

Atherosclerosis 2005;179:361-7

2)Drugs that lower CRP and their effect on outcome

Glitazones

JAMA 2007;298:1189-95

COX-2s

CMAJ 2002;166:1649-50

Fenofibrate

Lancet 2005;366;1849-61

Bezafibrate

Circulation 2000;102:21-7

Vitamin E

Lancet 2003;361:2017-23

JAMA 2007;297:842-57

Niacin

JAMA 1975;231:360-81

Ezetimibe

N Engl J Med 2008;358:1431-43

Statins

Lancet 2008;371:117-25

High dose statins – not treating to target

CMAJ2008;178(5):576-84

Episode 53 continues where we left with the whole CRP measurement or no measurement discussion. James and Mike start with the Reynolds Risk Score and show how even at the extremes of CRP, absolute risks only change by around +/- 2% or so. Far more interesting is that there are now 2 studies showing clearly that good estimates of cardiovascular risk can be made without knowing lab values like cholesterol and CRP. All you have to basically do is look at the patient. Mike looks at James and declares that James is at very high risk of annoying Mike – so he does, just to show the evidence is solid.

Show Notes

1) Reynolds Risk Score

www.reynoldsriskscore.org

2) CRP goes up as weight goes up

Diabetes Metab 2003;29:133-8

JAMA 1999;282:2131-5

3) Estimating cardiovascular risk estimates without knowing cholesterol or CRP

Lancet 2008;371:923–31

Eur J Card Prev RehabMay 2009