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Start Over Author "Shaozhao Zhang" Journal journal of diabetes investigation
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1. Effect of intensive lifestyle intervention on the association between weight variability and major adverse cardiovascular events in overweight or obese adults with type 2 diabetes mellitus

Author

Xiangbin Zhong, Xingfeng Xu, Menghui Liu, Peng Wang, Lixiang He, Odong Christopher, Shaozhao Zhang, Yifen Lin, Yiquan Huang, Zhenyu Xiong, Xiaodong Zhuang, and Xinxue Liao

Subjects
Intensive lifestyle intervention, Major adverse cardiovascular events, Weight variability, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

Abstract Aims/introduction Weight variability is associated with cardiovascular outcomes in diabetic patients. However, whether the guideline‐recommended intensive lifestyle intervention (ILI) will affect this association in overweight or obese adults with diabetes is not well established. Materials and Methods In 3,859 participants from the Action for Health in Diabetes (Look AHEAD) trial, the associations of 4 year weight variability measured by variability independent of the mean (VIM) with major adverse cardiovascular event (MACE) and secondary outcomes in ILI and diabetes support & education (DSE) arm were evaluated. Results During a median follow‐up of 9.6 years, 255 (12.9%) participants in the ILI arm and 247 (13.2%) participants in the DSE arm developed MACE. Participants with the highest quartile of weight variability (VIM Q4) experienced a 2.23‐fold higher risk of MACE compared with the lowest quartile (VIM Q1) in the DSE arm (hazard ratio [HR] 2.23; 95% CI 1.51–3.30). Compared with the lowest weight variability (VIM Q1), participants with the highest weight variability (VIM Q4) were associated with higher risks of secondary cardiovascular composite outcome (HR 1.88; 95% CI 1.20–2.95), all‐cause mortality (HR 3.19; 95% CI 1.75–5.82), and myocardial infarction (HR 1.95; 95% CI 1.12–3.37) in the DSE arm. Conclusions Among the overweight or obese individuals with type 2 diabetes mellitus, rising weight variability was independently associated with increased MACE risks in the DSE arm. Therefore, a guideline‐recommended ILI strategy for weight loss should be adopted to improve cardiovascular outcomes without worrying about the effect of weight fluctuations.

Published
2023
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2. Antiplatelet strategy in primary and secondary prevention of cardiovascular disease in patients with type 2 diabetes mellitus: A perspective from the guideline appraisal

Author

Peihan Xie, Yongqiang Fan, Xiaodong Zhuang, Xinxue Liao, Yifen Lin, Shaozhao Zhang, Huimin Zhou, Xiaohong Chen, Menghui Liu, Yiquan Huang, Xiangbin Zhong, Daya Yang, Lichun Wang, and Zhenyu Xiong

Subjects
Acute coronary syndrome, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Disease, Type 2 diabetes, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Antiplatelet strategy, Diabetes mellitus, Internal Medicine, medicine, Secondary Prevention, Humans, 030212 general & internal medicine, Intensive care medicine, Aspirin, Type 2 diabetes mellitus, business.industry, Dual Anti-Platelet Therapy, Type 2 Diabetes Mellitus, Percutaneous coronary intervention, General Medicine, Guideline, Articles, medicine.disease, Prognosis, Cardiovascular disease, Clinical Science and Care, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Practice Guidelines as Topic, Original Article, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract

Aims/Introduction To appraise guidelines on the antiplatelet strategy of prevention of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus, and highlight the consensuses and controversies to aid clinician decision‐making. Materials and Methods A systematic search was carried out for guidelines regarding CVD prevention or focusing on type 2 diabetes patients. Appraisal of Guidelines for Research and Evaluation II instrument was utilized to appraise the quality of included guidelines. Results Of the 15 guidelines with discrepant Appraisal of Guidelines for Research and Evaluation II scores (66%; interquartile range 51–71%), 10 were defined as “strongly recommended” guidelines. For secondary prevention, >60% of guidelines advocated that the dual antiplatelet therapy was used within 12 months when the type 2 diabetes patients experienced acute coronary syndrome and/or post‐percutaneous coronary intervention or coronary artery bypass grafting, with subsequent long‐term aspirin use. For primary prevention, 80% of guidelines supported that aspirin should not be routinely used by patients with type 2 diabetes. No consensus on whether to prolong dual antiplatelet therapy in secondary prevention, and whether to use aspirin in type 2 diabetes patients with high CVD risk exists in current guidelines. Conclusions Physicians should use the recommendations from “strongly recommended” guidelines to make informed decisions and know the consensuses of current guidelines. Dual antiplatelet therapy should be used within 12 months when type 2 diabetes patients experience acute coronary syndrome and/or percutaneous coronary intervention/coronary artery bypass grafting, with subsequent long‐term aspirin use. In primary prevention, aspirin should not be routinely used by individuals with type 2 diabetes, but might be considered for those with high CVD risk., The study appraised the current guidelines on the antiplatelet strategy of prevention of cardiovascular disease in patients with type 2 diabetes mellitus utilizing the Appraisal of Guidelines for Research and Evaluation II instrument. In conclusion, we found that current guidelines regarding the antiplatelet strategy of cardiovascular disease prevention for patients with type 2 diabetes still have considerable discrepancies, but the consensuses could help clinicians to make wise decisions in choosing an antiplatelet strategy for type 2 diabetes patients.

Published
2020

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