MONDAY, Nov. 10 (HealthDay News) -- Drug-coated stents appear to be superior to bare metal stents in both efficacy and safety in patients with diabetes, new research shows.
"I would say consistently from randomized trials that there is clear efficacy and clear reduction for repeat revascularization procedures [with drug-coated stents]," said senior study author Dr. Laura Mauri, an assistant professor of medicine at Brigham and Women's Hospital and Harvard Medical School. "That is now also augmented by the fact that there is excellent safety in patients who have a similar ability to take dual antiplatelet therapy."
"That's an important caveat," Mauri added. "I think we have to judge our patients and get to know them as individuals and make determinations on a case-by-case basis. I wouldn't make a blanket statement, but, in general, there is great benefit to the use of drug-eluting stents in diabetic patients, and there does not seem to be a trade-off."
Mauri presented the findings Monday at the American Heart Association's (AHA) annual scientific sessions in New Orleans.
The safety of drug-coated stents versus conventional bare metal stents has been a matter of controversy for years.
Diabetics have a higher prevalence of ischemic heart disease than the general population, but percutaneous coronary intervention (PCI) has limitations in this group, including a higher rate of restenosis and subsequent heart attack and death.
"There is controversy regarding selecting PCI as a treatment for patients with diabetes," said Dr. David Williams, with Brown University and Rhode Island Hospital in Providence. "One of the major shortcomings of PCI in this patient subset has been a relatively high need to perform repeat revascularization. Drug-eluting stents may offer a potential advantage in that regard, but there is some concern as to whether they are as safe as bare metal stents."
Mauri presented three-year follow-up data for a subgroup of about 5,000 diabetic patients undergoing PCI with stenting to reopen blocked vessels.
Two-thirds of the patients were treated with drug-eluting stents, and one-third were treated with bare metal stents.
There was an absolute reduction of around 5 percent in the need for repeat procedures in the target vessel and a small, but significant and surprising, decrease in death and subsequent heart attacks.
"It's appropriate to conclude that drug-eluting stents are superior to bare metal stents in patients with diabetes in regard to reducing the need for repeat revascularization. It also appears to be safe," Williams said. "Whether there's actually a benefit in terms of death and heart attack, I would say this is a provocative finding but not firmly established. This report indicates that probably the selection of bare metal stents over drug-eluting stents will be based on the ability of patients to take dual antiplatelet therapy for a sustained period of time."
A second study, from French researchers, presented at the meeting detailed a way to give individually tailored doses of Plavix (clopidogrel) to patients who had undergone PCI that still reduced the risk of blood clots.
Plavix is a notoriously tricky drug to deliver, as individual responses vary tremendously.
"We prescribe clopidogrel in a one-size-fits-all approach," explained AHA spokeswoman Dr. Nieca Goldberg. "They were looking at a way to individualize the drug."
"The message is 'yes, we can perform a therapeutic window for platelet therapy to avoid MACE [major adverse cardiovascular events] in patients," said senior study author Dr. Franck Paganelli, a professor of medicine in the division of cardiology at Hopital Nord, University of Marseille School of Medicine, in France.
"Trying to identify a loading dose using a lab test is a very creative idea," said AHA spokesman Dr. Elliott Antman. "We have to have a lot more information about the integrity of lab tests and how we should use them."
The authors of this study based their dosing on an index of platelet activity in patients undergoing stent placement.
More information
The American Heart Association 
has more on PCI.
THURSDAY, Nov. 6 (HealthDay News) -- Too many American adults are unaware of "pre-diabetes" and not enough take action to reduce their risk, according to a U.S. Centers for Disease Control and Prevention study released Thursday.
People with pre-diabetes -- a condition in which blood glucose levels are higher than normal but not high enough to be classified as diabetes -- are at increased risk for developing type 2 diabetes, heart disease and stroke. But lifestyle changes such as diet and exercise can prevent or delay development of diabetes and its complications.
More than 25 percent of Americans have pre-diabetes but, in 2006, only 4 percent of adults had ever been told they had the condition, said the CDC researchers, who analyzed data on about 24,000 adults who took part in the 2006 U.S. National Health Interview Survey.
There are five conditions indicative of pre-diabetes -- pre-diabetes itself, impaired fasting glucose, impaired glucose tolerance, borderline diabetes, and high blood sugar. Of the 984 people in the study who'd been told they had pre-diabetes, 64.4 percent were told they had borderline diabetes, 38.3 percent were told they had high blood sugar, 33.7 percent were told they had pre-diabetes itself, 15.5 percent were told they had impaired glucose tolerance, and 15. 2 percent were told they had impaired fasting glucose. In addition, 43.3 percent were told they had two or more of the five conditions.
Rates of pre-diabetes increased with age, ranging from 2.7 percent among those ages 18 to 44 to 6 percent among those over age 65. Rates also increased with weight -- 2.3 percent among those with normal weight, 3.9 percent among those who were overweight, and 6.3 percent among those who were obese.
The study also found that pre-diabetes was more common among women (4.8 percent) than men (3.2 percent), but found no significant race/ethnicity-related differences.
Of the 984 people who'd been told they had pre-diabetes, 68 percent tried to lose or control weight, 55 percent increased their levels of physical activity, and 60 percent reduced their intake of dietary fat or calories. Only 42 percent engaged in all three risk reduction activities, and 24 percent didn't participate in any of these activities, the study found.
The study was published in this week's issue of the Morbidity and Mortality Weekly Report, a CDC journal. It echoes a prior study, published in the same journal on Oct. 31, that found that the U.S. rate of new cases of full-blown type 2 diabetes has doubled over the past decade from 4.5 cases per 1,000 people in 1995-1997, to 9.1 cases per 1,000 people by 2007. The suspected cause: rising obesity rates.
It's not too late to turn those numbers around, experts said. "An important opportunity exists to reduce the preventable burden of diabetes and its complications by increasing awareness of pre-diabetes among those who have the condition, and encouraging the adoption of healthier lifestyles and risk reduction activities among all U.S. adults," the researchers wrote in a summary of their study.
They added that people at increased risk for diabetes should lose or control their weight, increase their physical activity levels, and be tested according to published recommendations.
More information
The U.S. National Diabetes Education Program has more about diabetes and pre-diabetes.