Sinclair, H. (2010). Diabetes and Cardiovascular Disease Challenges and Strategies. 42nd Annual New York Cardiovascular Symposium.
Summary of the article
This scientific paper describes the causal relationship that exists between diabetes mellitus (DB) and cardiovascular diseases in a study dubbed ACCORD. Throughout the paper, the author provides an overview of key results obtained from this cohort study (ACCORD) that investigated the risk factors of CVD posed by different glucose levels among DM subjects. In addition, the paper undertakes a critical evaluation of this particular study results finding by analyzing various similar studies that have recently been undertaken in the same field. Notable studies, that have been discussed by the author in this paper are two; titled ADVANCE and UKPDS. The research methodology used in conducting the central study (ACCORD) whose findings are being discussed here was designed as a cohort study of 10,251 cases that were subdivided twice and assigned to two treatment regimes i.e. intensive and standard therapy.
The major findings of this paper based on the analysis of the various studies cited therein show that three outcomes were correlated with DM among cases receiving any of the two therapies that included nonfatal stroke, myocardial infarction and cardiovascular-related mortalities. Subjects assigned to intensive therapy had the highest mortality rates that peaked at 3.5 years on average which interfered with the research study that was intended to continue for several years. These findings were consistent with other research studies done on the subject which indicated that regulation of glucose levels among DM cases generally reduced the risk factors of cardiovascular diseases. Finally, the article briefly reviews other compounding factors of DM conditions such as metabolic syndromes and recommends that a multi-strategy approach be adopted in the management of DM cases.
Assessment of the Article
This paper does indeed indicate that a causal effect exists between DM condition and CVD related morbidities demonstrated by the hazard ratio of CV causes that was at 1.35 which is further disaggregated by category. The study also indicates that the resulting mortality or mobility is compounded by the nature of treatment that is assigned to the subject. This paper tackles and addresses two major issues comprehensively; one, it sets out to prove that DM condition is a risk factor of CVD, and two it analyzes the implications that the treatment therapy is likely to have on the subject. Thus, the article is a reflection of extensive studies which have been done on these specific issues that are discussed in the paper.
In fact, this paper makes interesting findings on key research studies that the author discusses here. One of these findings is that mortality rates were highest among cases that did not exhibit reduced HbA1c levels and those who had these levels being above 7%. This observation is consistent with ADVANCE study results which conclude that use of “drugs to achieve HbA1c levels ≤6.5%) reduced the incidence of combined major macrovascular and microvascular events” which translates to reduced mortality and morbidity rates. Besides this, another study by UKPDS appears to support this since it states that “Subjects who received intensive glucose therapy had a lower risk of microvascular complications compared with those who received conventional therapy”. This study is consistent with the above findings when you consider that conventional therapies (that rely on dietary restrictions) are less effective in regulating HbA1c levels which we have seen ought’s to be at least below 7%. In addition, the results of the findings indicated certain trends that were correlated with the type of therapy that was assigned to the cases such as high mortality rates among cases under intensive treatment therapy. The implications of these findings have significant applications not only in the clinical setting but also in the nursing profession.
Reflection of the paper
The research findings that are summarized and compared by the paper on different studies provide opportunities for healthcare in different specialities to apply these findings in the management of DM cases and CDV conditions among patients. Among the most obvious applications of these findings discussed above is that health specialists can advise DM patients on risk factors of CDV and thereby contribute to reducing the CDV related prevalence or mortality and morbidity among this group of patients. What is more, is that caretakers such as nurses would now be in a position to advise their patients on the best treatment methods based on their efficacy as evidenced in the paper and which would ideally hope to maintain the HbA1c levels below 7% which we have determined to be the most appropriate. Finally, this paper highlights factors those caretakers can observe which act as predictors of DM conditions among cases and which can be used in the early detection of cases.