Multifaceted Approach to Diabetes Management

Source: Tufts University
March 28, 2003

Clinicians already know that people with diabetes are several times more likely than the general population to suffer from cardiovascular disease. Keeping potentially life-threatening complications at bay takes constant monitoring of concurrent health problems, but as reported in a recent issue of the New England Journal, aggressive treatment can markedly cut diabetes-related vascular complications.

Different levels of treatment

In this current analysis, researchers in Denmark recruited 160 adults with type 2 diabetes with persistent microalbuminuria. Half received their usual treatment from their own healthcare provider, with treatment goals for controlling blood glucose, blood pressure, and serum lipids set at levels considered manageable by a person with diabetes.

The other half received 'intensive' treatment that included counseling on diet, exercise, and smoking cessation. Hypertension and hyperglycemia were managed with medications, which were increased if the current doses were not producing acceptable results. This group was encouraged to aim for treatment goals similar to what would be expected in a healthy individual - blood pressure of 130/80 mmHg, total cholesterol less than 175 mg/dL (4.5 mmol/L), and triglycerides less than 150 mg/dL (1.7 mmol/L).

After almost 8 years of follow-up, participants who received intensive treatment were only about half as likely as those who received conventional treatment to suffer from cardiovascular disease (hazard ratio= 0.47, 95% CI, 0.24-0.73). They were also much less likely to suffer from autonomic neuropathy (hazard ratio= 0.37, 95% CI, 0.18-0.79), nephropathy (hazard ratio= 0.39, 95% CI, 0.17-0.87), and retinopathy (hazard ratio= 0.42, 95% CI, 0.21-0.86).

The importance of good control

These findings underscore the fact that just keeping blood glucose in check isn't enough. Most people with type 2 diabetes have concurrent health problems that also need to be addressed. This study demonstrated that paying close attention to all the risk factors for cardiovascular disease - excess weight, hypertension, and dyslipidemia - substantially reduces the likelihood of complications.

But making major diet, exercise, and lifestyle changes is hard work, even with the kind of ongoing support that the 'intensive' treatment group received. As the author of an accompanying editorial pointed out, even with steady support, less than 20% of this group was able to achieve optimal blood glucose control, and less than half were able to maintain a healthy systolic blood pressure.

Advice to clinicians

Treatment protocols similar to the one tested in this study are already part of national guidelines for the management of type 2 diabetes. However, the author of an accompanying editorial feels that they are currently underused, because they require a considerable investment of time and education by both the physician and the patient. But this is time and effort well spent, especially for those patients with type 2 diabetes and microalbuminuria who are at increased risk for vascular complications.

Source

• Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. P. Gaede, P. Vedel, N. Larsen,  et al., N Engl J Med, 2003, vol. 348, pp. 383--393

Related Links
Managing Cardiovascular Disease in Type 2 Diabetes
Exercise Helps Control Diabetic Vascular Disease
Angiotensin-Receptor Antagonists in Type 2 Diabetes
To quickly access additional accurate information on this and other nutrition-related topics, visit Tufts University's Nutrition Navigator

Please take a moment to give us your comments. For questions about Health matters you may check our "Questions & Answers" Portal and Service.