Diabetes breakthrough may help millions avoid unneeded meds

Research by Professor Rod Jackson’s team suggests international treatment guidelines for diabetes are over-estimating patients’ risks of cardiovascular problems such as heart disease and stroke.

That means some patients will be receiving expensive drug treatments they don’t really need, according to the research, just published as Cardiovascular risk prediction in type 2 diabetes before and after widespread screening: a derivation and validation study.

New Zealand’s world-leading role in screening for cardiovascular risk includes testing almost every middle-aged adult for diabetes. This means this country is at the forefront of research into diabetes, a chronic health condition that is surging along with obesity, affecting hundreds of millions of people.

Professor Jackson led a team that included scientists in the Faculty of Medical and Health Sciences at the University, along with colleagues in the field at the Waitemata, Auckland and Counties Manukau district health boards, the University of Otago and the Ministry of Health.

While international treatment guidelines regard most people with diabetes to be at high risk of cardiovascular problems, the team showed how boosting screening for diabetes – capturing more of the diabetes population – alters risk profiles.

In New Zealand, a world-first national programme led to approximately 90 per cent of eligible adults being screened for diabetes by 2016, up from 50 per cent in 2012. The broader screening identified many asymptomatic patients with recent-onset diabetes.

"We hypothesised that cardiovascular risk prediction equations derived prior to widespread screening would now significantly overestimate risk," the researchers wrote in the paper.

That did, indeed, turn out to be case, in a study of 46,652 patients.

"These findings have significant international implications as increased diabetes screening is inevitable due to increasing obesity, simpler screening tests, and the introduction of new-generation glucose-lowering medications that prevent cardiovascular events," the researchers said.

In Aotearoa, the research is already making a difference. "For the first time, general practitioners here are able to use risk prediction equations developed in New Zealand and derived from New Zealand patients," says Jackson. "Most GPs are now using them. These are currently the most accurate equations in the world for predicting risk of heart attacks and strokes in people with diabetes."

Funding for the research came from the Health Research Council of New Zealand, Heart Foundation of New Zealand and Healthier Lives National Science Challenge.