| Type 2 diabetes: Which interventions best reduce absolute risks of adverse events? | |
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MedLine Citation:
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PMID: 19508839 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Benefits of interventions are usually reported as relative risk reductions. Absolute risk reductions (ARRs)-most relevant to individual patients-are reported less often. OBJECTIVES: Estimate ARRs for interventions in a patient with diabetes mellitus. METHODS: We used the Archimedes Risk Assessment Tool to estimate 10-year risks of myocardial infarction (MI), cerebrovascular accident (CVA), end-stage renal disease (ESRD), blindness, foot ulceration, and amputation, and to estimate the ARRs associated with controlling blood pressure (BP), blood sugar, and low-density lipoprotein (LDL) cholesterol levels; moderate exercise; and taking aspirin and a beta-blocker. Our hypothetical base case was a 65-year-old white man. Three other hypothetical patients were a 50-year-old white man, a 65-year-old white woman, and a 65-year-old black man. Each patient had a 5-year history of diabetes mellitus, a sedentary lifestyle, body mass index (BMI) of 28 kg/m2, BP of 140/90 mm Hg, LDL of 120 mg/dL, high-density lipoprotein (HDL) of 45 mg/dL, and glycosylated hemoglobin (HbA1c) of 10%. RESULTS: For the base case, the risks of MI (22.3%) and CVA (14.4%) far exceeded the risks of ESRD, blindness, and amputation. ARRs for interventions to reduce MI risk were: aspirin, 6.8%; HbA1c to 7%, 5.1%; moderate exercise, 2.7%; BP to 130/80 mm Hg, 1.4%; and LDL to 100 mg/dL, 1.4%. The female patient had a lower ARR for aspirin and a greater ARR for exercise. The black male patient had greater ARRs for both aspirin and exercise. Estimates were similar for CVA. CONCLUSION: Patients resembling our base case and its variations would probably benefit more from aspirin and moderate exercise than from all other interventions combined. |
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Authors:
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Brian Firestone; James W Mold |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: The Journal of family practice Volume: 58 ISSN: 1533-7294 ISO Abbreviation: J Fam Pract Publication Date: 2009 Jun |
Date Detail:
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Created Date: 2009-06-10 Completed Date: 2009-07-17 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7502590 Medline TA: J Fam Pract Country: United States |
Other Details:
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Languages: eng Pagination: E1 Citation Subset: AIM; IM |
Affiliation:
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Department of Family and Preventive Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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African Continental Ancestry Group* Aged Amputation Blindness / etiology, prevention & control Cardiovascular Diseases / etiology, prevention & control Diabetes Mellitus, Type 2 / complications*, ethnology, therapy* Diabetic Foot / etiology, prevention & control European Continental Ancestry Group* Female Humans Kidney Failure, Chronic / etiology, prevention & control Male Middle Aged Reproducibility of Results Risk Assessment Treatment Outcome |
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