Early Treatment for Type 2 Diabetes - The Better
If you've got type 2 diabetes, the sooner you get
intense about reining in your blood sugar, the better. It also pays
to buckle down on your blood pressure and stay that way.
That's the message from a long-term study of adults with type 2
diabetes.
It's not news that controlling blood sugar and blood pressure are
musts for managing type 2 diabetes. But the new findings show that
doing so promptly and intensively are key.
What's the payoff? Less likelihood of a heart attack and a healthier
cardiovascular system, for starters, according to the findings
published in The New England Journal of Medicine.
Curbing Blood Sugar
First, the study focused on blood sugar control, comparing a purely
dietary approach to intensive drug therapy using medications called
sulfonylureas, insulin, or metformin.
Some 5,100 British adults newly diagnosed with type 2 diabetes were
assigned to one of those treatment plans. They stayed with the study
for six to 20 years.
When the study ended, it was clear that complications in tiny blood
vessels were rarer in the intensive drug therapy groups than in the
diet-only group.
That advantage was still paying dividends a decade later.
Long-Term Perk
When the study ended in 1997, the patients were free to follow
whatever type 2 diabetes treatment they chose with their doctors.
Most started taking diabetes drugs.
That doesn't mean they abandoned diet; it just means that they were
all allowed to take drugs, too. A healthy diet is a staple of
diabetes care.
Over the next 10 years, people formerly in the intensive drug
therapy group were less likely to have a heart attack or develop
diabetes-related complications, compared with people who had been in
the diet-only group.
The early, intensive approach to blood sugar control amounted to a
head start. The researchers — who included Rury Holman, FRCP, of
Churchill Hospital in Oxford, England — call that a "legacy effect."
Blood Pressure: Keep It Down
Holman's team also compared intensive and not-so-intensive
approaches to blood pressure among the diabetes patients in their
study. High blood pressure, like diabetes, makes heart disease (and
a host of other serious conditions) more likely.
More than 1,100 participants were either assigned to take an ACE
inhibitor or a beta-blocker to reach a certain blood pressure goal.
For comparison, other patients with high blood pressure got an
easier blood pressure goal and didn't have to take ACE inhibitors or
beta-blockers.
When the study ended, the patients who took the intensive approach
were less likely to have died from diabetes, had a stroke, or
developed diabetes-related complications.
But two years later, when the patients could handle their blood
pressure however they wanted to, it was a different story.
By then, blood pressure had crept up in the patients who had been in
the intensive group, and dropped in the comparison group. That
erased the benefit gaps between the groups; there was no "legacy
effect."
The bottom line: Optimal blood pressure control is "of major
importance ... in patients with type 2 diabetes but must be
maintained if these benefits are to be sustained," Holman and
colleagues conclude.
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