NOACs associated with lower risk for diabetic complications and mortality compared with warfarin

1. NOACs associated with lower risk for diabetic complications and mortality compared with warfarin

Abstract: https://www.acpjournals.org/doi/10.7326/M21-3498

URL goes live when the embargo lifts

A retrospective cohort study of patients with atrial fibrillation and diabetes found that the use of non–vitamin K antagonist oral anticoagulants (NOAC) was associated with a lower risk of diabetes complications and mortality than warfarin. These findings suggest that NOAC may be a better therapeutic choice for this patient population. The study is published in Annals of Internal Medicine.

Patients diagnosed with atrial fibrillation are more likely to have a stroke in their lifetime and are often prescribed long-term oral anticoagulants including warfarin and NOACs for stroke prevention. Diabetes is also common among these patients, with poor glycemic status putting them at risk for thromboembolism and cardiovascular mortality, as well. Which anticoagulant is associated with a lower risk of these complications for these patients is not clear.

Researchers from National Taiwan University and Hualien Tzu Chi Hospital conducted studied data from Taiwan's National Health Insurance Research Database, which collects healthcare data from 23.6 million of the country’s residents, to compare the hazards of diabetes complications and mortality between patients with atrial fibrillation and diabetes without end stage renal disease receiving NOACs and those receiving warfarin. Of the 19,909 NOAC users and 10,300 warfarin users studied, those taking NOAC had significantly lower hazards of developing macrovascular complications, microvascular complications, glycemic emergency, and all-cause mortality. Analyses with propensity score matching showed similar results and several sensitivity analyses further supported the robustness of the findings. While the study could not determine the exact mechanisms of the better outcomes in NOAC users, the authors suggest possible contributing factors could include the beneficial effects of Vitamin K on insulin sensitivity and glucose tolerance and the difference in anticoagulation mechanism between NOAC and warfarin.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. Authors Yu-Kang Tu, DDS, MSc, PhD and Huei-Kai Huang, MD can be reached directly at yukangtu@ntu.edu.tw or drhkhuang@gmail.com.

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2. National Clinical Care Commission summarizes recommendations for improving federal diabetes programs

Focusing on individuals at high risk for type 2 diabetes should be a priority

Specialists in internal medicine have a singular and important role in facilitating national diabetes prevention and care strategy

Abstract: https://www.acpjournals.org/doi/10.7326/M21-4175  

URL goes live when the embargo lifts

In 2017, Congress directed the U.S. Department of Health and Human Services to convene the National Clinical Care Commission (NCCC) to evaluate and make recommendations to improve federal programs that impact diabetes and its complications. The NCCC, comprised of 23 members with expertise in diabetes epidemiology, public health, clinical care, patient advocacy, health policy, and regulatory matters, has made recommendations to improve diabetes prevention and care. The committee suggests that internal medicine specialists will have a singular and important role in facilitating the critical steps needed to achieve their goals. A summary of the NCCC recommendations is published in Annals of Internal Medicine.

The NCCC identified several opportunities to improve diabetes prevention and care through greater coordination of health-related and non–health-related federal agencies and recommends creating an Office of National Diabetes Policy. They say that all Americans at risk for and with diabetes must have access to high-quality and affordable health care, and federal policies and programs must promote health equity. In addition, focusing diabetes prevention efforts among those at high risk has the potential to greatly reduce the incidence of type 2 diabetes and its complications. Safe and effective methods to delay or prevent type 2 diabetes include intensive lifestyle change programs, such as the National Diabetes Prevention Program, and use of metformin. However, uptake among the at-risk population is low and must be improved. These are among the 39 specific recommendations outlined in the paper and summarized in several topic areas: Federal programs and policies; Population-level programs to prevent diabetes, facilitate treatments, and promote health equity; Type 2 diabetes prevention; Insurance coverage; Diabetes care delivery; and Diabetes research.

The NCCC strongly encourages Congress and the Health and Human Services (HHS) Secretary to swiftly implement its recommendations. They say that doing so will substantially benefit the health and quality of life of people at risk for living with diabetes, promote health equity, and support clinicians as they assist patients with diabetes prevention and treatment efforts.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Paul R. Conlin, MD, please contact Winfield S. Danielson III at Winfield.Danielsoniii@va.gov or Deirdre Salvas at Deirdre.Salvas@va.gov.

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Abstract: https://www.acpjournals.org/doi/10.7326/M21-4075