British trial shows clear effects of treatment, especially blood pressure reduction

Editorial p 691 Papers pp 703, 713, 720

More than three decades ago Harry Keen pinpointed two “bad companions” to diabetes: high blood glucose concentrations and high blood pressure, both associated with microalbuminuria. The long running UK prospective diabetes study has recently extended the number of bad companions to include dyslipidaemia and smoking.1 Owing to the complexity of the disease, however, and the slow but progressive development of complications over many years, well founded intervention strategies against diabetic complications have been largely lacking in type 2 diabetes. Papers from the UK study published this week in the BMJ and the Lancet now offer clinicians some effective treatment options.

The UK prospective diabetes study started by studying the value of various strategies to achieve tight blood glucose control compared with looser control, but the researchers soon became aware that high blood pressure may be an even stronger risk factor—as we originally observed in diabetic renal disease2—gand blood pressure treatment was therefore included in the study. The UK study has thus provided answers to a range of important questions that have haunted diabetes researchers and clinicians for years.

Does a policy of tightly controlling blood glucose concentration reduce the risk of complications in type 2 diabetes? Yes, it does, and, as far as reducing the risk of microvascular complications is concerned, sulphonylureas and insulin produce equally good results.3 The blood glucose study showed only inconclusive evidence of a reduced risk of myocardial infarction, but a key finding is that neither regimen produced specific adverse cardiovascular outcomes. The beneficial effect was also seen …