To remember
- The enduring glycaemic effects observed during the post-trial monitoring study in the intensive sulfonylurea or insulin therapy group, compared to the conventional therapy group, persisted over the 14 years following the conclusion of the initial adherence study, with overall reductions in relative risk from baseline of:
- 10% (p = 0.015) for death from all causes;
- 17% (p = 0.002) for myocardial infarction;
- 26% (p
- The corresponding absolute risk reductions were 2.7%, 3.3%, and 3.5%, respectively.
- No significant reduction in the risk of stroke or peripheral vascular disease was noted with insulin/sulfonylureas during or after the trial.
- The persistent effects of metformin observed during the post-trial surveillance study in the metformin group, compared with the conventional therapy group, also did not lessen over the subsequent 14 years, with overall reductions in relative risk from baseline of:
- 20% (p = 0.010) for death from all causes;
- 31% (p = 0.003) for myocardial infarction.
- The corresponding absolute risk reductions were 4.9% and 6.2%, respectively.
- No significant reduction in the risk of stroke, peripheral vascular disease, or microvascular disease was observed with metformin during or after the trial.
In practice
« Our results demonstrate persistent effects throughout almost the entire life span of early intensive glycemic control with sulfonylurea or insulin and metformin. Achieving near-normal glycemia immediately after the diagnosis of type 2 diabetes seems essential to minimize the risk of diabetes-related complications during life as much as possible. », write the authors.
Source
The study was led by Dr. Amanda I. Adler, PhD, director of the Diabetes Trials Unit at the Radcliffe Department of Medicine, University of Oxford (University of Oxford), in Oxford, UK, and colleagues, and was published online on May 17, 2024, in the journal The Lancet.
Limits
Data for 130 participants in the UKPDS study were missing. No laboratory measurements or drug therapy information were available during the extended follow-up. Only events requiring hospitalization or outpatient procedures were considered, and events were not adjudicated. The sample size decreased over time.
Funding and links of interest
The study was funded by the University of Oxford Nuffield Department of Population Health Seed Funding Scheme (University of Oxford Nuffield Department of Population Health). Most authors reported conflicts of interest.
This article was translated from Medscape.co.uk using multiple editorial tools, including AI, in the process. The content was reviewed by the editorial staff before publication.
To Remember
- The persistent glycaemic effects observed during the post-trial monitoring study in the intensive sulphonylurea or insulin therapy group, compared with the conventional therapy group, did not abate over the 14 years following the end of the initial adherence study, with overall reductions in relative risk from baseline of:
- 10% (p = 0.015) for death from all causes;
- 17% (p = 0.002) for myocardial infarction;
- 26% (p = 0.001) for other cardiovascular events.
- The corresponding absolute risk reductions were 2.7%, 3.3%, and 3.5%, respectively.
- No significant reduction in the risk of stroke or peripheral vascular disease was observed with insulin/sulfonylureas during or after the trial.
- The persistent effects of metformin observed during the post-trial surveillance study in the metformin group, compared with the conventional therapy group, also did not diminish over the following 14 years, with overall reductions in relative risk, from baseline, of:
- 20% (p = 0.010) for death from all causes;
- 31% (p = 0.003) for myocardial infarction.
- The corresponding absolute risk reductions were 4.9% and 6.2%, respectively.
- No significant reduction in the risk of stroke, peripheral vascular disease, or microvascular disease was observed with metformin during or after the trial.
In Practice
« Our results demonstrate persistent effects throughout almost the entire lifespan of early intensive glycemic control with sulfonylurea or insulin and metformin. Achieving near-normal glycemia immediately after the diagnosis of type 2 diabetes seems essential to minimize as much as possible the risk of diabetes-related complications during life. », write the authors.
Benefits of Early and Intensive Glycemic Control
Early and intensive glycemic control is vital for individuals diagnosed with type 2 diabetes. The study led by Dr. Amanda I. Adler emphasizes long-term benefits associated with such management strategies. Here are some noteworthy benefits:
- Reduced Risk of Mortality: With a 10% relative risk reduction for death from all causes in the intensive treatment group, the implications for longevity are profound.
- Lower Incidence of Myocardial Infarction: An impressive 17% relative risk reduction for myocardial infarction showcases the direct heart health benefits of rigorous glycemic control.
- Improved Long-Term Health Outcomes: The continued benefits observed even 14 years post-trial participation underline the necessity for early intervention.
Practical Tips for Achieving Glycemic Control
Managing blood sugar effectively requires a combination of lifestyle adjustments, medication adherence, and ongoing monitoring. Here are some practical tips:
- Regular Monitoring: Check blood glucose levels frequently using a reliable meter to recognize patterns and adjust your regimen accordingly.
- Healthy Eating: Adopt a balanced diet rich in whole grains, lean proteins, fruits, and vegetables. Limit sugars and refined carbohydrates.
- Regular Physical Activity: Engaging in physical activity for at least 150 minutes a week can significantly improve insulin sensitivity and blood glucose control.
- Medication Management: Adhere to prescribed medication, whether sulfonylureas, metformin, or insulin. Consult your healthcare provider for any necessary adjustments.
Case Studies: Real-Life Impacts of Glycemic Control
Examining individual cases can illustrate the profound impacts of early intensive glycemic control:
| Patient | Initial HbA1c | Glycemic Control Strategy | Outcomes After 10 Years |
|---|---|---|---|
| John Doe | 9.0% | Sulfonylurea + lifestyle change | HbA1c reduced to 6.5%, no MI or stroke |
| Jane Smith | 8.5% | Metformin + insulin | HbA1c stable at 7.0%, 20% reduction in all-cause mortality |
Long-Term Management Strategies
After experiencing successful glycemic control, maintaining that achievement is equally vital. Here are a few long-term management strategies:
- Continuous Education: Stay informed about diabetes management through workshops, webinars, and support groups.
- Regular Consultations: Frequent check-ups with healthcare professionals to adjust treatment plans and monitor any complications.
- Emotional Support: Joining diabetes support groups to connect with others facing similar challenges can provide encouragement and insight.
Source
The study was led by Dr. Amanda I. Adler, PhD, director of the Diabetes Trials Unit at the Radcliffe Department of Medicine, University of Oxford (University of Oxford), in Oxford, UK, and was published online May 17, 2024, in the journal The Lancet.
Limits
Despite the compelling findings, several limitations within the study should be noted:
- Missing data for 130 participants in the UKPDS study
- Absence of laboratory measurements or drug therapy information during extended follow-up
- Only events requiring hospitalization or outpatient procedures were considered
- Events were not adjudicated, and the sample size decreased over time
Funding and Links of Interest
The study was funded by the University of Oxford Nuffield Department of Population Health Seed Funding Scheme (University of Oxford Nuffield Department of Population Health). Most authors reported conflicts of interest.
This article was translated from Medscape.co.uk using multiple editorial tools, including AI, in the process. The content was reviewed by the editorial staff before publication.
