Individualized Treatment Targets for T2D and Hypertension
Individualized Treatment Targets for T2D and Hypertension
A large body of evidence indicates that type-2 diabetes mellitus (T2DM) is an important independent risk factor for cardiovascular disease (CVD). In fact, those with diabetes are 2 to 4 times more likely to develop CVD, which is the leading cause of mortality in patients with T2DM. In addition, the prevalence of hypertension is more than double in diabetic patients compared to those with normal blood glucose levels, making it the most common comorbid disease associated with T2DM. Hypertension has been found to increase the risk of nephropathy, retinopathy, left ventricular hypertrophy, and cardiovascular events in patients with T2DM.
Current guidelines have recommended a multi-factorial approach for treating diabetic patients with hypertension, involving simultaneous targeting of blood pressure (BP) and glucose levels. Although there has been a recent focus on individualized treatment targets in patients with T2DM, guidelines have not been sufficiently translated into clinical practice. Moreover, adequate guidance with regard to individualized BP targets remains to be established. Thus, in order to define effective criteria for individualized treatment approaches, information regarding patient characteristics that might be associated with specific HbA1c and BP target groups as well as investigation into the efficacy of meeting individualized therapeutic goals set by physicians in daily clinical practice are fundamental. This is especially important considering that drugs that perform well within specialized populations in clinical trials are often less effective when employed in clinical practice. Thus, it is also essential to carefully evaluate whether treatment targets can be met using specific antidiabetic and antihypertensive therapies in unselected patient populations and within real clinical settings. For this reason, comparisons between different drug classes are required.
The ongoing DIALOGUE registry represents the first study to assess the effectiveness, tolerability, and impact of different therapeutic approaches in patients with T2DM and hypertension while applying newly established individualized treatment targets recommended by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Here, we aimed to characterize patients based on their chosen therapeutic targets as well as actual target achievement rates (overall and by comorbidity). Furthermore, we identified patient characteristics associated with loose treatment goals.
Background
A large body of evidence indicates that type-2 diabetes mellitus (T2DM) is an important independent risk factor for cardiovascular disease (CVD). In fact, those with diabetes are 2 to 4 times more likely to develop CVD, which is the leading cause of mortality in patients with T2DM. In addition, the prevalence of hypertension is more than double in diabetic patients compared to those with normal blood glucose levels, making it the most common comorbid disease associated with T2DM. Hypertension has been found to increase the risk of nephropathy, retinopathy, left ventricular hypertrophy, and cardiovascular events in patients with T2DM.
Current guidelines have recommended a multi-factorial approach for treating diabetic patients with hypertension, involving simultaneous targeting of blood pressure (BP) and glucose levels. Although there has been a recent focus on individualized treatment targets in patients with T2DM, guidelines have not been sufficiently translated into clinical practice. Moreover, adequate guidance with regard to individualized BP targets remains to be established. Thus, in order to define effective criteria for individualized treatment approaches, information regarding patient characteristics that might be associated with specific HbA1c and BP target groups as well as investigation into the efficacy of meeting individualized therapeutic goals set by physicians in daily clinical practice are fundamental. This is especially important considering that drugs that perform well within specialized populations in clinical trials are often less effective when employed in clinical practice. Thus, it is also essential to carefully evaluate whether treatment targets can be met using specific antidiabetic and antihypertensive therapies in unselected patient populations and within real clinical settings. For this reason, comparisons between different drug classes are required.
The ongoing DIALOGUE registry represents the first study to assess the effectiveness, tolerability, and impact of different therapeutic approaches in patients with T2DM and hypertension while applying newly established individualized treatment targets recommended by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Here, we aimed to characterize patients based on their chosen therapeutic targets as well as actual target achievement rates (overall and by comorbidity). Furthermore, we identified patient characteristics associated with loose treatment goals.
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