Rapid Improvement of Glycemic Control in Type 2 Diabetes Using Weekly Intensive Multifactorial Interventions: Structured Glucose Monitoring, Patient Education, and Adjustment of Therapy—A Randomized Controlled Trial

Background: We evaluated intensive intervention in poorly controlled patients with type 2 diabetes mellitus involving weekly clinic visits and adjustment of therapy with analysis of three seven-point glucose profiles and intervention from an interdisciplinary staff.Methods: Sixty-three patients were randomized to an intensive treatment group that obtained self-monitoring of blood glucose (SMBG) profiles (six or seven values per day, 3 days/week) and were seen in the clinic at Weeks 1-6 and 12. SMBG results were downloaded, analyzed using Accu-Chek (R) 360 degrees software (Roche Diagnostics, Indianapolis, IN), and used to adjust therapy. Control group subjects obtained glucose profiles and had clinic visits only at Weeks 0, 6, and 12.Results: There were highly statistically significant improvements in the intensive treatment group compared with the control group between Weeks 0 and 6 with greater reductions in weekly mean glycemia (WMG) (-76.7 +/- 8.9 mg/dL vs. -20.5 +/- 8.1mg/dL), glycemic variability (SD) (-16.3 +/- 3.1 mg/dL vs. -5.0 +/- 3.1mg/dL), and glycated hemoglobin (-1.82 +/- 0.16% vs. -0.66 +/- 0.22%) without significant changes in frequency of hypoglycemia or weight. Improvements were sustained in the intensive treatment group through Week 12. A minimal but statistically significant degree of improvement was seen in the control group at Week 12.Conclusions: This short-term pilot study of an intensive monitoring, educational, and pharmacological interventions program resulted in dramatic improvement of glycemic control within 6 weeks, and these effects are sustained through Week 12. SMBG glucose profiles, calculation of WMG and SD, and graphical displays of glucose data can improve the effectiveness of adjustment of therapy at weekly clinic visits when combined with intensive support from a multidisciplinary team.Diabetes Education and Control Group of the Kidney and Hypertension Hospital, Federal University of São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Diabet Educ & Control Grp, BR-04038002 São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Ctr Hypertens & Cardiovasc Metabol, BR-04038002 São Paulo, BrazilBiomed Informat Consultants, Potomac, MD USAUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Diabet Educ & Control Grp, BR-04038002 São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Ctr Hypertens & Cardiovasc Metabol, BR-04038002 São Paulo, BrazilWeb of Scienc

Diabetes and cardiovascular disease: from evidence to clinical practice – position statement 2014 of Brazilian Diabetes Society

Abstract There is a very well known correlation between diabetes and cardiovascular disease but many health care professionals are just concerned with glycemic control, ignoring the paramount importance of controlling other risk factors involved in the pathogenesis of serious cardiovascular diseases. This Position Statement from the Brazilian Diabetes Society was developed to promote increased awareness in relation to six crucial topics dealing with diabetes and cardiovascular disease: Glicemic Control, Cardiovascular Risk Stratification and Screening Coronary Artery Disease, Treatment of Dyslipidemia, Hypertension, Antiplatelet Therapy and Myocardial Revascularization. The issue of what would be the best algorithm for the use of statins in diabetic patients received a special attention and a new Brazilian algorithm was developed by our editorial committee. This document contains 38 recommendations which were classified by their levels of evidence (A, B, C and D). The Editorial Committee included 22 specialists with recognized expertise in diabetes and cardiology