Word: heart
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...Among the patients who were screened, 5.5% needed procedures, such as bypass or angioplasty, to restore blood flow to the heart during the course of the trial. A similar proportion, 7.8%, of unscreened patients required similar procedure. The difference was not statistically significant, meaning that the screening did little to predict or prevent heart problems in diabetes patients...
...that screening didn't appear to provide any health advantage, Wackers theorizes, may be that patients with diabetes (particularly the ones being monitored carefully in the study) are already benefiting from well controlled blood sugar - in patients, both with diabetes and without, high blood sugar is associated with increased heart risk. So, if diabetes patients are already being treated for potential heart risk factors before they become hazardous, screening becomes redundant...
...Wackers stresses, however, that these findings do nothing to diminish the very real risk of heart disease in diabetics. A 1998 Finnish study documented that diabetes patients who had not suffered a heart attack had the same poor health profile as those who had - findings that prompted the American Diabetes Association to recommend heart-disease screening for all diabetes patients with two or more additional risk factors for heart disease, such as high cholesterol or hypertension, even in the absence of symptoms. "That study really changed the field," says Wackers, "and told us we cannot miss the risk of heart...
...With his latest findings, however, Wackers thinks the ADA guidelines are ready for a revision. Heart screenings may not be as important as basic primary prevention strategies, such as ensuring that diabetes patients control their weight, cholesterol and blood pressure, and stop smoking. He argues that if the rate of heart problems is indeed declining in diabetes patients because they are being adequately treated for the risk factors for heart disease, then the stress test recommendation becomes redundant - and expensive...
...John Buse, a DIAD investigator and immediate past president of the American Diabetes Association, agrees that the screening should be limited. "We probably should not be doing stress tests in people without heart symptoms," he says. "But doctors need to make sure to ask questions of their patients about any possible symptoms they may be having of heart trouble...