Clinical questionBottom-line answer
13. Blood pressure target in patients with diabetesThe best target seems to lie between 140 and 150 mm Hg.
What is the appropriate antihypertensive treatment goal for patients with diabetes?21 Although most recent practice guidelines have relaxed the blood pressure goals for patients with diabetes, there are still a few holdouts that suggest aggressive treatment. This meta-analysis shows that the ideal range for hypertension control in patients with diabetes is between 140 and 150 mm Hg; higher or lower sustained blood pressure increases mortality, the so-called J-curve.
14. Metabolic targets in patients older than 80 yearsPatients fare worse with low A1C, blood pressure, and cholesterol levels.
Is there an association between mortality and glycemic control, blood pressure levels, and cholesterol levels in patients with type 2 diabetes who are older than 80 years?22 Although subject to many of the limitations of cohort studies, the data from this study are consistent with those from many other studies that suggest that older patients are worse off with low glycosylated hemoglobin (A1C), low blood pressure, and low cholesterol levels.
15. Mediterranean diet and weightA Mediterranean diet produces sustained weight loss.
What is the effect of a Mediterranean-type diet on body weight?23 In addition to lowering cardiovascular event risk, a Mediterranean diet produced a greater sustained weight loss than a low-fat diet and a similar weight loss as other diets in patients who were overweight or obese, most of whom had type 2 diabetes. The range of average weight loss was 3.8 to 10.1 kg (8.4 to 22.3 lb) after one year with a Mediterranean diet vs. a loss of 5.0 kg (11.0 lb) to a gain of 2.9 kg (6.4 lb) with a low-fat diet.