Practice Evidence Based Case Report

Aspirin in type 2 diabetes: is there any evidence base?

BMJ 2008; 337 doi: (Published 16 October 2008) Cite this as: BMJ 2008;337:a1902
  1. Maie Walsh, medical student1,
  2. Geoffrey Spurling, senior lecturer2
  1. 1University of Queensland, Royal Brisbane Hospital, Herston, Qld 4029, Australia
  2. 2Discipline of General Practice, University of Queensland, Royal Brisbane Hospital
  1. Correspondence to: G Spurling g.spurling{at}
  • Accepted 24 April 2008

Aspirin is routinely given to patients with type 2 diabetes to prevent cardiovascular events, but does this practice have any evidence base?

While I (MW) was observing general practitioner consultations as a medical student, a 46 year old woman with type 2 diabetes presented for prescriptions. Because this is a common presentation, I thought this was one consultation that I should tune into. The patient’s diabetes was well controlled by diet and lifestyle alone. Her most recent glycated haemoglobin value was 6.1%. Hypercholesterolaemia (total cholesterol/high density lipoprotein cholesterol 4.2) and hypertension (blood pressure 125/80 mm Hg) were effectively managed with drugs. She was a regular smoker, which gave her an absolute cardiovascular risk of 5-10% (New Zealand cardiovascular risk calculator; over five years. However, one of the drugs she was taking didn’t make sense to me, so I asked my supervisor why someone with well controlled diabetes who was otherwise healthy should be on aspirin. “It’s routine to give someone with type 2 diabetes aspirin,” he assured me. I must have looked unconvinced because his initial confidence faltered and gave way to a slightly uncertain frown. We wondered, “What is the evidence base behind routinely prescribing aspirin in type 2 diabetes?”

Searching for the evidence

I decided to use this question as a subject for an upcoming evidence based medicine assignment, a component of my assessment for the general practitioner rotation. I began by consulting the National Health and Medical Research Council (NHMRC) guidelines because these are used by doctors throughout Australia as a benchmark for clinical practice. The current guidelines stated that unless contraindicated, low dose prophylactic aspirin (75-350 mg) is recommended to prevent potential macrovascular complications associated with type 2 diabetes.1 A few weeks later, the general practice had an evidence based medicine journal club where my question was developed …

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