Data on the efficacy of antiplatelet therapy for primary prevention in patients with diabetes are limited. The only prospective randomized study has been the Early Treatment Diabetic Retinopathy Study (ETDRS), which enrolled 3711 diabetic patients in the 1980s and randomized them to aspirin 650 mg/ day or placebo.107 The administration of aspirin over
5 years was associated with a nonsignificant reduction in all-cause mortality and in fatal or nonfatal MI (RR = 0.91 and 0.83, respectively). In the secondary prevention setting, the Antiplatelet Trialist Collaboration demonstrated that prolonged use of an anti-platelet agent (mainly aspirin) among 5126 diabetic patients was associated with only a modest, nonsignificant benefit over placebo (RRR = 7%).108 Information on which oral antiplatelet agent may be best suited for diabetic patients in the prevention setting can be derived from a subgroup analysis of the only large-scale head-to-head comparison, the Clopido-grel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial. Among 3866 diabetic patients, the adenosine diphosphatase (ADP) (P2Y12) receptor antagonist clopidogrel (75 mg/day) was found to be superior to aspirin (325 mg/day) in the composite of ischemic and bleeding events over 2 years (RRR = 14.5%).109 Accordingly, the number of ischemic or bleeding events prevented with clopidogrel per year among 1000 treated patients was 9 in the nondia-betic group, 21 in the diabetic group overall, and 38 in the insulin-treated group. These results were not considered to be strong enough, and aspirin remains the first-line antiplatelet agent for CV prevention, even among diabetic patients. The ADA recommends aspirin (72 to 162 mg/day) indefinitely for all diabetic patients with evidence of CVD and in the primary prevention setting for individuals older than 40 years of age with one or more CV risk factors or albuminuria.110
The Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial investigated the safety and efficacy of long-term administration of aspirin (75 to 162 mg/day) and clopidogrel (75 mg/day), compared with aspirin alone, in patients with established atherosclerotic disease or with multiple CV risk factors.111 In the large diabetic population enrolled (n = 6556), no benefit of the combination therapy was observed after a median follow-up of 28 months, whereas the
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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.