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Towards personalised treatment for diabetes mellitus

(Vienna, 11 March 2016) 600,000 to 800,000 Austrians suffer from diabetes mellitus. Thanks to the biomarker known as NT-proBNP (a hormone specific to the heart), the sub-group of people who are at increased risk of cardiovascular disease can be determined even though their hearts appear to be healthy. This group accounts for around 40 per cent of all diabetics. Researchers at the University Departments of Internal Medicine II and III at the MedUni Vienna have now demonstrated in the PONTIAC I Study that high-dose, personalised therapy with ACE inhibitors and beta blockers can significantly reduce the risk of cardiac disease among affected patients – by as much as 64 per cent. Now, researchers at the MedUni Vienna are looking to continue this successful approach with the PONTIAC II Study involving a general population of patients with type 2 diabetes without cardiac disease. PONTIAC II has now been launched.

A total of 300 patients with diabetes mellitus and increased NT-proBNP levels but who had no history of heart disease took part in PONTIAC I. In the follow-on study, two randomised groups of 2,400 participants will be used to compare the preventative effect of high-dose therapy with renin-angiotensin system antagonists and beta blockers with conventional therapy. “The primary end point will be the influence on the number of unplanned hospital admissions and mortality rates after two years,” explain the study leaders Raphael Wurm and Martin Hülsmann from the University Department of Internal Medicine II at the MedUni Vienna.
Part of the aim of PONTIAC II is to confirm the results of the PONTIAC I study. Another part is to test the extent to which the primary preventative effect is limited exclusively to an at-risk population characterised by a raised NT-proBNP. If this is successful, it would be the first successful approach to personalised treatment in type 2 diabetes.
Ophthalmology department offers support with sub-study
The study is also being supported by the University Department of Ophthalmology and Optometry at the MedUni Vienna (led by Ursula Schmidt-Erfurth) as part of a sub-study. Under the supervision of Sonja Prager, the relationship between diabetic retinopathy and the over-activity of cardiovascular hormones will be investigated. The planned work has already been commended by the highly respected DOC Bursary of the Academy of Sciences. These results could also give rise to completely new approaches to treating retinopathy.

The study is currently starting in Austria with the following centres, the majority of which have already taken part in PONTIAC:
•    University Department of Internal Medicine III at the MedUni Vienna, Clinical Department of Endocrinology and Metabolic Medicine (led by: Anton Luger)
•    Rudolfstiftung Hospital 1st Medical Department with Diabetology, Endocrinology and Nephrology (led by: Bernhard Ludvik)
•    Hietzing Hospital 3rd Medical Department with Metabolic Diseases and Nephrology (led by: Rudolf Prager)
•    WGKK “Ambulatorium Süd” (led by: Helmut Brath),
•    KH der Barmherzigen Brüder Linz (led by: Martin Clodi).
Other international centres are currently in the pipeline.

Roche Diagnostics is the cooperation partner on the study.