An estimated 10.9 percent of the adult population in China suffers from diabetes, while nearly 36 percent are affected by prediabetes, according to research published in the Journal of the American Medical Association (JAMA). An international trial published in Circulation, exploring intensive risk factor modification, suggests that significant opportunities exist to improve secondary prevention among patients with diabetes and a history of cardiovascular disease. Such intervention could lead to a reduction in risk for cardiovascular events, particularly in populations with high concentrations of individuals with diabetes and prediabetes, as exhibited in China.

Over recent years, studies have shown a rapid increase in the prevalence of diabetes in China, which now houses the world's largest diabetes epidemic. Analyzing data from a nationally representative 2013 survey of 170,287 participants in mainland China, study authors Limin Wang, MPH, et al., found that, among Chinese adults with diabetes, 36.5 percent were aware of their diagnosis, while only 32.2 percent were treated.

In a separate study, published in Circulation, Neha J. Pagidipati, MD, MPH, et al., evaluated secondary prevention for cardiovascular disease in patients with type 2 diabetes. They measured the attainment of five parameters—aspirin use, lipid control, blood pressure control, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use and non-smoking status—among 13,616 patients with diabetes and a known history of cardiovascular disease from 38 countries.

"Appropriate secondary prevention can improve cardiovascular disease outcomes in adults with diabetes," write the study authors. "Intensive combined modification of multiple risk factors has been demonstrated to significantly improve the long-term outcomes among patients with diabetes and cardiovascular disease."

Pagidipati et al., found 29.9 percent of patients with diabetes and cardiovascular disease achieved all five of the secondary prevention parameters at baseline, and 71.8 percent of patients achieved at least four parameters. North America had the highest proportion of achievement at 41.2 percent, while Western Europe, Eastern Europe and Latin America reached proportions of approximately 25 percent. Achievement of individual prevention components varied by region in this trial; compared with North America, those in the Asia Pacific region were more likely to be on aspirin therapy and to be nonsmokers at baseline. Additionally, lower rates of blood pressure control were seen in the Asia Pacific region. Individually, blood pressure control had the lowest overall attainment at 57.9 percent, while non-smoking status had the highest at nearly 90 percent.

"Achievement of guideline-recommended prevention measures can reduce cardiovascular disease risk in adults with diabetes and a history of cardiovascular disease, yet the degree to which these high-risk adults are achieving guideline-indicated secondary prevention interventions has been understudied globally," write Pagidipati, et al. "Our analysis suggests that on a global scale, less than one-third of patients with diabetes and CVD are receiving optimal CVD secondary preventive care."

The study authors highlighted that multiple risk factors, like hypertension, dyslipidemia and smoking, increase the risk of more severe outcomes in patients with diabetes and cardiovascular disease. They emphasized the strong association observed between an increasing number of secondary prevention measures and improved outcomes, encouraging the implementation of aggressive risk factor modification in the routines of patients with diabetes and a history of cardiovascular disease.

Keywords: Risk Factors, Prediabetic State, Diabetes Mellitus, Type 2, Secondary Prevention, Cardiovascular Diseases, China

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