May be high risk, low benefit

doi:10.1136/bmj.39520.531319.3A

BMJ 2008;336:683 (29 March), doi:10.1136/bmj.39520.531319.3A

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Very tight glucose control

May be high risk, low benefit

The first 150 words of the full text of this article appear below.

The problems with a glucocentric approach to managing patientswith type 2 diabetes¹ ² ³ can be seen using data from the UKPDS.⁴In the 10 years of follow-up of newly diagnosed patients witha mean age of 53, macrovascular events (myocardial infarctionand stroke) were five times more common than serious microvascularevents (blindness in one eye and renal failure) but, unlikethese, were not significantly reduced by intensive glucose lowering.Moreover the observational data from the study² showed a substantiallyless steep relation of mean concentrations of HbA_1c levels over10 years with macrovascular risk than with microvascular risk.These data imply that if glycaemia per se has a role in theaetiology of macroangiopathy, the maximal potential benefitfrom a 1% reduction in HbA_1c is 14% for myocardial infarctionand 12% for stroke. Intervention studies with statins and antihypertensiveshave shown benefits of around twice these amounts.⁵ A qualitative. . . [Full text of this article]

John S Yudkin, emeritus professor of medicine, University College London

¹ London N7 0AG

j.yudkin@ucl.ac.uk

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