Population-Based Strategy for Preventing Diabetes and its Complications
A recent report from the American College of Physicians should cause a paradigm
change for the treatment of diabetic patients.
The main purpose of diabetes therapy is the prevention of complications.
The endpoint of many clinical trials is to lower blood glucose levels, but intensive
treatments aimed at lowering the HbA1c to less than 6.5% are often accompanied
by hypoglycemia as a side effect.
At the same time, intensive regimens have not shown a reduction of cardiovascular
complications in the longterm.3-7 For example, the action to control cardiovascular risk in
diabetes trial was prematurely discontinued, following the observation of an increase in overall mortality, cardiovascular-related deaths, and severe hypoglycemic events.
The action in diabetes and vascular disease; preterAx and diamicroN-MR controlled evaluation
study also failed to show a statistically significant clinical benefit, while more adverse effects were
seen among those who achieved a median HbA1c level of 6.4%.4
More intensive treatments with tight glycemic control targets are more costly and associated
with increased patient burdens. Only Hollan et al8 reported a long-term benefit with intensive therapy in
the United Kingdom prospective diabetes study after 10 years of intervention.
Multidrug intervention trials were also reviewed. The Steno-2 study planned to examine if multifactorial interventions meant to decrease blood glucose, blood pressure and lipids in type-2 diabetes patients, could reduce
the risks of microangiopathy, macroangiopathy, and premature deaths.
After a median follow-up of 13.3 years, an overall 20% absolute reduction in the risk of death was observed in the intensive-therapy group, as compared with the conventional-therapy group.
Diabetes Res Open J. 2018; 4(1): e1-e4. doi: 10.17140/DROJ-4-e011
