Letters

Treating type 2 diabetes

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7184.666a (Published 06 March 1999) Cite this as: BMJ 1999;318:666

Study was conducted in exemplary fashion

  1. K M Venkat Narayan, Chief (kav4@cdc.gov),
  2. Gloria L A Beckles, Epidemiologist,
  3. Edward W Gregg, Epidemiologist,
  4. David F Williamson, Epidemiologist,
  5. J Saaddine, Medical epidemiologist,
  6. Michael M Engelgau, Chief, Epidemiology and Statistics Branch,
  7. Frank Vinicor, Director
  1. Diabetes Epidemiology Section
  2. Division of Diabetes Translation, National Center for Chronic Disease, Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, 30341, USA
  3. Department of Cardiology, Skejby University Hospital, DK-8200 Aarhus N, Denmark
  4. Department of Family Practice, Naval Hospital Jacksonville, Jacksonville, Florida 32214, USA
  5. Morlais Medical Practice, Merthyr Tydfil, Mid Glamorgan CF48 3AL
  6. UK Prospective Diabetes Study Group, Diabetes Research Laboratories, Nuffield Department of Clinical Medicine, Radcliffe Infirmary, Oxford OX2 6HE

    EDITOR>—The United Kingdom Prospective Diabetes Study has shown over 10 years of follow up that people with newly diagnosed type 2 diabetes can maintain excellent glycaemic control (concentrations of haemoglobin A1c of 7%) and that this can significantly reduce microvascular complications.1 It has also shown that strict blood pressure control can significantly reduce mortality as well as microvascular and macrovascular complications among these people.2 The study group thus answered its primary research questions. The design of the study meant that several secondary questions could not be answered convincingly.3 Several lessons in ethics and public health can, however, be learnt.

    The fact that the comparison group maintained a comparatively low concentration of haemoglobin A1c (7.9%) over 10 years of follow up means that the researchers were ethical to the point of risking a null finding. In contrast, in their enthusiasm to establish the efficacy of specific treatment(s) some investigators replace standard drug treatment with an inactive placebo.4 The researchers continuously adapted the intervention to changes in scientific knowledge and clinical practice, which is reasonable and justifiable in a 20 year trial that chooses to adhere to sound ethical principles.

    The study was conducted in primary healthcare settings rather than specialist centres or university hospitals, and the results are therefore likely to be closer to clinical practice …

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