title: Blood pressure, lipids and glucose in type 2 diabetes: how low should we go? Re-discovering personalized care.
abstract: Epidemiological studies have clearly shown a direct relationship between the levels of blood pressure, glycaemia and LDL-cholesterol, and the complications of diabetes. Although 'lower should be better', the results of recent clinical trials examining the benefits of normalizing risk factor levels have been counter-intuitive and, at times, disturbing, and have called into question this notion. This review focuses on patients with type 2 diabetes who make up 90% of patients with diabetes. It aims to provide a clear summary and interpretation of recent trials to help clinicians to set targets for cardiovascular risk factors in individual patients. It highlights areas of agreement and disagreement between current guidelines. Recent data indicate that some patient subgroups might respond differently to aggressive risk factor management. Our challenge is how to identify these patients and deliver truly personalized diabetes care that maximizes benefit, and minimizes harm. Guidelines and position statements stress the value of setting personalized targets. We explore what this means, and how this might be achieved in practice by outlining some solutions to issues that currently limit the delivery of personalized care. We call for further research assessing the overall clinical impact of cardiovascular risk factor intervention by finding appropriate ways of combining data on mortality, complications, side-effects, quality of life, and cost-effectiveness.
authors.affiliation: Cardiovascular Research Group, Core Technology Facility, School of Biomedicine, University of Manchester, 46 Grafton Street, Manchester, UK. Martin.Rutter@manchester.ac.uk
authors.forename: Martin K
authors.initials: MK
authors.lastname: Rutter
authors.forename: Richard W
authors.initials: RW
authors.lastname: Nesto
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D008078:Cholesterol, LDL / Q000378:metabolism; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control*; D058607:Fibric Acids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000517:prevention & control*; D006973:Hypertension / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008055:Lipids; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL; D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D008055:Lipids