03/28/2003 - Articles

Close Attention to Health Goals Benefits People with Diabetes

By: Tufts University

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Most people with diabetes already know that the disease puts them at increased risk for cardiovascular problems. Keeping potentially life-threatening complications at bay takes constant monitoring of health details - weight, blood pressure, cholesterol - but the results are worth it, as illustrated by a study published in the New England Journal of Medicine .

Varying treatments

To test the effectiveness of different levels of diabetes treatment, Danish researchers recruited 160 adults with type 2 diabetes. Half of the group remained under the usual care of their own doctors, with treatment goals for managing blood glucose, blood pressure, cholesterol, and triglycerides set at levels considered manageable by a person with diabetes.

The other half received 'intensive' treatment that included counseling on diet, exercise, and smoking cessation. High blood pressure and blood glucose were managed with medications, which were increased if the current doses were not producing acceptable results. This group was encouraged to aim for treatment goals similar to what would be expected in a healthy individual - blood pressure of 130/80, total cholesterol less than 175 mg/dL (4.5 mmol/L), and triglycerides less than 150 mg/dL (1.7 mmol/L).

After almost 8 years of follow-up, participants who received intensive treatment were only about half as likely as those who received conventional treatment to suffer from cardiovascular disease. They were also much less likely to suffer from autonomic neuropathy (nerve damage) and retinopathy (eye damage), both complications of diabetes.

The importance of good control

Just keeping high blood sugar in check isn't enough, since most people with type 2 diabetes have concurrent health problems that also need to be addressed. Diabetes puts a strain on blood vessels, increasing the risk of damage to both the tiny capillaries (like those in the eyes and extremities) and large arteries. This study showed that paying attention to all the risk factors for cardiovascular disease - excess weight, high blood pressure, and high cholesterol - substantially reduces the likelihood of complications.

But making major diet, exercise, and lifestyle changes is hard work, even with the kind of ongoing support that the 'intensive' treatment group received. As the author of an accompanying editorial points out, even with steady support, less than 20% of this group was able to achieve optimal blood glucose control, and less than half were able to maintain a healthy systolic blood pressure. But the hard work did paid off, greatly cutting the participants' risk of cardiovascular complications.

For more information on how to limit the cardiovascular complication of diabetes, connect to the National Diabetes Information Clearinghouse (see first link below).

Source

Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.
P. Gaede, P. Vedel, N. Larsen,  et al., N Engl J Med, 2003, vol. 348, pp. 383--393

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Created on: 03/18/2003
Reviewed on: 03/28/2003

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