Issue 174 Item 14Early Control Predicts Diabetic Complication Risk

Early glucose and blood pressure control predict later complication risks in type 2 diabetes.

In a 5-year follow-up study of patients who participated in the 10-year (1987-1997) United Kingdom Prospective Diabetes Study, differences in outcomes persisted between newly diagnosed patients randomized to intensive glucose or blood pressure control and those on conventional treatment. The differences remained even though the two study groups had nearly equivalent hemoglobin A1c and blood pressure values during the 5 years after the trial ended, said Dr. Holman of the University of Oxford (England).

In one arm of the trial involving 3,867 patients, risk reductions among those who achieved a mean hemoglobin A1c of 7% via intensive treatment with sulfonylureas were 12% for any diabetes-related end point, 10% for diabetes-related death, and 6% for all-cause mortality, compared with patients on diet alone who had an average A1c of 7.9% (Lancet 352[9131]:837-53, 1998).

During 5 years of follow-up after the trial, A1c levels had risen to 7.8% in 1,229 patients who had been in the intensive group, and to 8.5% in 467 former conventionally treated patients. Just 24% of the total group achieved the recommended value of less than 7%. But early analysis suggests that the reduction in risk of diabetes-related and mortality end points in the intensive group are nearly identical to what they were at the end of the UKPDS, Dr. Holman said.

In another part of the UKPDS, 1,148 hypertensive type 2 diabetic patients were randomized to “tight” blood pressure control with an ACE inhibitor or -blocker versus standard control. The tight-control patients, having achieved a mean blood pressure of 144/82 mm Hg at 9 years, had 24% fewer diabetes-related end points, 32% fewer diabetes-related deaths, 44% fewer strokes, and 37% fewer microvascular end points than did the less-tight-control group, who had mean blood pressures of 154/87 mm Hg (BMJ 317[7160]:703-13, 1998).

Among 522 of those patients followed for 5 years, blood pressures were 143/79 mm Hg in the tight-control and 150/83 mm Hg in the standard-control groups, which are not significantly different. But reductions in risk for nearly all of the end points studied in the initial trial were significantly greater for the tight-control group, although the reductions were about one-third less in magnitude than what they were at the end of the original trial, Dr. Holman said.

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