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2288 pages added, reviewed or updated during the last month (last updated: 19/4/2021)


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  • 5,102 newly diagnosed patients with type II diabetes
  • prospective, randomised intervention trial

General conclusions:

  • intensive blood glucose control by either sulphonylurea or insulin substantially reduced the risk of microvascular complications, but not macrovascular disease (e.g. stroke, myocardial infarction), in type II diabetics

  • intensive glucose control with metformin decreased the risk of diabetes related complications in obese type II diabetics; metformin was associated with fewer hypoglycaemic attacks and less weight gain than insulin and sulphonylureas

  • tight blood pressure control is associated with a lower risk of death and complications related to diabetes; the correlation between blood pressure and cardiovascular disease appears to have no lower threshold - a target blood pressure of 135/85 mmHg or less is appropriate

  • captopril and atenolol were equally effective in reducing diabetic complications

  • target glycosylated haemoglobin concentration should be 7.0% or less

Follow-up after 10 years:

  • glycaemic control
    • between-group differences in glycated hemoglobin levels were lost after the first year
        • in the sulfonylurea-insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P=0.04) and microvascular disease (24%, P=0.001), and risk reductions for myocardial infarction (15%, P=0.01) and death from any cause (13%, P=0.007) emerged over time, as more events occurred.
        • in the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002)
      • despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients (3)
  • tight blood pressure control
    • benefits of previously improved blood-pressure control were not sustained when between-group differences in blood pressure were lost. Early improvement in blood-pressure control in patients with both type 2 diabetes and hypertension was associated with a reduced risk of complications, but it appears that good blood-pressure control must be continued if the benefits are to be maintained (4)

Reference:

Last reviewed 07/2019

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