Determining if implementation of the haptoglobin phenotype biomarker should be tested in type 2 diabetes treatment planning to prevent cardiovascular disease: a biostatistical analysis, a cost-effectiveness analysis, and a patient priority analysis

People with type 2 diabetes have a higher risk of heart disease compared to people without type 2 diabetes. However, studies of strict blood sugar control (aiming for near-normal blood sugar levels) among people with type 2 diabetes have not prevented heart disease and have even caused harm in some people. This has made it hard for patients with type 2 diabetes and their doctors to decide on blood sugar goals. The type of the blood protein 'haptoglobin' that a person has may have played a role in these surprising results. Everyone's body makes one of two major haptoglobin types, which can be found out by a simple blood test. I published a study previously in which I re-analyzed data from one of these completed studies in each of the two haptoglobin groups separately. I found that strict blood sugar control prevented heart disease in people with one haptoglobin type, but people with the other type had no heart disease benefit and even had an increased risk of death. I now want to find out: (1) which groups of people and types of blood sugar control haptoglobin type predicts heart disease in; (2) whether using a person's haptoglobin type to tell which people will benefit from strict blood sugar control will save the Canadian health care system money; and (3) whether people with type 2 diabetes like the idea of using their haptoglobin type in their blood sugar plan. My research will help us learn whether the haptoglobin type blood test can consistently tell which people will benefit from strict blood sugar control and who will not. It will also tell us whether we should further test the haptoglobin type blood test with doctors and patients in clinics to personalize blood sugar control goals. Nearly 2.3 million people in Canada and 450 million people worldwide are living with type 2 diabetes, and so research like mine that aims to personalize blood sugar lowering treatment to prevent heart disease could impact millions of people.