Type 2 diabetes: Which interventions best reduce absolute risks of adverse events?

Benefits of interventions are usually reported as relative risk reductions. Absolute risk reductions (ARRs)-most relevant to individual patients-are reported less often.

Estimate ARRs for interventions in a patient with diabetes mellitus.

We used the Archimedes Risk Assessment Tool to estimate 10-year risks of myocardial infarction (MI), cerebrovascular accident (CVA), end-stage renal disease (ESRD), blindness, foot ulceration, and amputation, and to estimate the ARRs associated with controlling blood pressure (BP), blood sugar, and low-density lipoprotein (LDL) cholesterol levels; moderate exercise; and taking aspirin and a beta-blocker. Our hypothetical base case was a 65-year-old white man. Three other hypothetical patients were a 50-year-old white man, a 65-year-old white woman, and a 65-year-old black man. Each patient had a 5-year history of diabetes mellitus, a sedentary lifestyle, body mass index (BMI) of 28 kg/m2, BP of 140/90 mm Hg, LDL of 120 mg/dL, high-density lipoprotein (HDL) of 45 mg/dL, and glycosylated hemoglobin (HbA1c) of 10%.

For the base case, the risks of MI (22.3%) and CVA (14.4%) far exceeded the risks of ESRD, blindness, and amputation. ARRs for interventions to reduce MI risk were: aspirin, 6.8%; HbA1c to 7%, 5.1%; moderate exercise, 2.7%; BP to 130/80 mm Hg, 1.4%; and LDL to 100 mg/dL, 1.4%. The female patient had a lower ARR for aspirin and a greater ARR for exercise. The black male patient had greater ARRs for both aspirin and exercise. Estimates were similar for CVA.

Patients resembling our base case and its variations would probably benefit more from aspirin and moderate exercise than from all other interventions combined.