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Early Intensive Glucose Control Lasts a Decade

A 10-year follow-up of a landmark trial of intensive glucose control in type 2 diabetes has suggested that the clinical benefit was more than durable but rose with the passage of time, researchers reported recently.

A decade after patients randomized to intensive glucose control completed the trial, they still had evidence of significant microvascular benefit, said Dr. Rury R. Holman, of the Diabetes Trials Unit of the Oxford Center for Diabetes in England. What’s more, a once-nonsignificant decrease in the risk of heart attack had matured into a significant 15 percent reduction and there was a 13 percent reduction in the relative risk of death from any cause, said Dr. Holman and colleagues.

The benefits, both microvascular (e.g., eye, kidney, or nerve damage) and macrovascular (e.g., heart attacks or stroke), of early intensive diabetes control persisted despite the fact that 10 years of ordinary care erased the impressive between-group blood sugar differences seen at the end of the active intervention.

Dr. Holman and co-investigators from the United Kingdom Prospective Diabetes Study (UKPDS) reported the findings at the European Association for the Study of Diabetes, and they were published online in two manuscripts by the New England Journal of Medicine (NEJM).

The findings represented 30 years of data-20 years of active intervention and 10 years of follow-up—from 5,102 patients enrolled in the trial.

One of the NEJM papers dealt with a substudy that studied the carryover effect of tight blood pressure control. In this case, the investigators found that the microvascular and macrovascular benefit of tight control of blood pressure, evident at the end of the active treatment phase, were not sustained during the 10-year follow-up.

Acknowledging that there was no legacy-effect for blood pressure, the investigators concluded that although optimal blood pressure control is of “major importance” in reducing the risks of microvascular and macrovascular complications, maintaining the benefit requires ongoing, aggressive hypertension therapy.

Dr. Edwin Gale, of Bristol University in England, who was not involved in the trial, said the results represent a true legacy in that they reinforce the benefit of early, intensive glucose management.

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