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You encourage your patients with type 2 diabetes to maintain tight glycemic control. Now you can back up your advice with a large new study that dramatically documents the long-term health benefits, which remained even if patients maintained tight glycemic control only for the first year after diagnosis.
At the start of the study, researchers randomly assigned 4,209 patients with newly diagnosed type 2 diabetes to receive either conventional therapy (diet restrictions) or intensive therapy with sulfonylurea, insulin, or metformin (for overweight patients). In the follow-up study, researchers tracked 3,277 of these patients for 10 years, testing blood glucose levels for the first 5 years, then tracking patients with questionnaires.
During the initial phase of the study, researchers found a lowered incidence of eye disease and kidney damage in patients in the intensive blood glucose control group compared with the conventional group. They didn't find any significant differences in myocardial infarction (MI) risk, except in the group of overweight people taking metformin.
Within 1 year of the initial study's end, differences in blood glucose control between the two groups disappeared. Even so, compared with the diet group, patients in the sulfonylurea group had a 15% lower risk of MI and a 13% lower risk of death in the 10-year follow-up period. Researchers also noted a continued benefit from meformin for overweight patients.
The findings indicate that tight glycemic control early in the disease process has prolonged health benefits, even if glucose control becomes more lax over time. Experts warn, however, that ongoing tight glucose control is still the best treatment approach.
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HAW. 10-year followup of intensive glucose control in type 2 diabetes. New Eng J Med.http://content.nejm.org/cgi/content/abstract/NEJMoa0806470. Accessed September 10, 2008.
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