Editorials

Managing diabetes after myocardial infarction

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7093.1497 (Published 24 May 1997) Cite this as: BMJ 1997;314:1497

Time for a more aggressive approach

  1. Malcolm Nattrass, Consultant physiciana
  1. a Selly Oak Hospital, Birmingham B29 6JD

    The Diabetes Control and Complications Trial (DCCT) produced clear evidence that intensive management of insulin dependent diabetes helped delay the onset or progression of microangiopathic complications of diabetes.1 This major randomised control trial confirmed and extended observations from smaller studies of the relation between diabetic control and the development of small vessel disease and neuropathy. However, no previous studies have argued convincingly for a relation between diabetic control and macrovascular disease, which remains the major cause of mortality in diabetic patients and makes a substantial contribution to morbidity. The Diabetes Control and Complications Trial came closest to this conclusion when reporting a highly suggestive, but non-significant (P=0.082), reduction in macrovascular events in the intensive treatment group.2

    In patients with non-insulin dependent diabetes the situation is less clear, with evidence still awaited for a relation between diabetic control and microvascular complications. Furthermore, since these patients are hyperinsulinaemic, researchers …

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