Lower CV Risk -- With a Diabetes Drug

I want to share with you a fascinating case that I just saw in clinic. Usually, my cases in diabetes clinic are fascinating because of a blood glucose problem, but this patient was fascinating because of his cardiovascular risk and how I believe I was able to help reduce it.

The patient is a 52-year-old man with type 2 diabetes and cardiovascular disease. He was referred by his cardiologist so that I could treat his diabetes to lower his cardiovascular disease risk.

"Well, what's your A1c?" I asked.

"My A1c has been around 6%," he replied.

"Then your diabetes is well-controlled," I said.

"No," he said. "You have to do better. I just had another stent."

"Oh, that's too bad," I said. "How many stents have you had?"

"Eight. Every 4-6 months, I seem to need another stent in a different artery. They say that I'm going to need bypass surgery or worse if I don't fix this ongoing atherosclerotic process."

And I said, "Well, I'm not so sure that it's your diabetes. Your diabetes is well controlled."

But then I thought about it. He was on metformin and sitagliptin. His A1c level in my office was 6.4%. His blood pressure was incredibly well controlled, and he was on a maximal-dose statin. Despite all this, he was having accelerated atherosclerosis that was leading to chest pain, his need for stents, and his worsening cardiovascular situation.