Intended for healthcare professionals

Editorials

Tight control of blood glucose in long standing type 2 diabetes

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b800 (Published 06 March 2009) Cite this as: BMJ 2009;338:b800

Definitions of 'tight control' are not consistent.

Lehman and Krumholz point out that the patients in the UK Prospective
Diabetes Study (UKPDS)[1] were different from those in the more recent
studies because they were younger and had newly diagnosed diabetes.[2,3]
In fact the difference is more fundamental than that: ‘tight control’ in
the recent studies is completely different to the ‘tight control’ in
UKPDS, and thus the intervention in UKPDS was completely different.

The median Hba1c in the treatment groups in UKPDS was 7.9% (those
treated with insulin / sulphonylurea) and 8.4% (those treated with
metformin). The mean Hba1c in the ‘tight control’ group in ACCORD was 6.4%
(vs 7.5% in controls). The mean Hba1c in the ‘tight control’ group in
ADVANCE was 6.5% (vs 7.3% in controls).

The ‘tight control’ in UKPDS which resulted in long term benefits was
an Hba1c of around 8%. This would equate to the control groups in ACCORD
and ADVANCE. The message from all the studies is the same: Hba1c between 7
-8% is good; Hba1c < 7% is bad.

1. Holman R, Paul S, Bethel MA, Matthews D, Neil A. 10-year follow up
of intensive glucose control in type 2 diabetes. N Engl J Med
2008;359:1577-89.

2. Action to Control Cardiovascular Risk in Diabetes Study Group.
Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med
2008;358:2545-59.

3. ADVANCE Collaborative Group. Intensive blood glucose control and
vascular outcomes in patients with type 2 diabetes. N Engl J Med
2008;358:2560-72.

Competing interests:
I am a GP whose practice depends on QOF for part of its income, but prefers not to harm patients with unnecessary treatment

Competing interests: No competing interests

12 May 2009
David K Lewis
General Practitioner
Vauxhall Primary Health Care, Limekiln Lane, Liverpool L5 8XR