Long-term gains from early diabetes treatment

European association for the study of Diabetes meeting Research on 'legacy effect'.

Treating patients with type-2 diabetes early with medication can significantly reduce long-term complications, UK research shows.

The landmark UKPDS trial initially followed 5,102 patients from 1977 to 1997 and showed that complications of diabetes could be reduced by improving either blood glucose control, BP control or both.

After the trial, all surviving patients were returned to community or hospital-based diabetes care, but with no attempt or intervention to maintain them on their randomised therapies.

Patients were assessed over a 10-year, post-trial period.

Results presented at the EASD conference in Rome this week showed that between 1997 and 2007, relative risk reductions for MI and all-cause mortality persisted in patients who received blood glucose control during the original trial.

For MI, patients taking suphonylureas and insulin had a relative risk reduction of 16 per cent in 1997 and 15 per cent in 2007, and for all-cause mortality these figures were 6 per cent and 13 per cent.

Patients taking metformin had relative risk reductions for MI of 39 per cent in 1997 and 33 per cent in 2007, and 36 per cent and 27 per cent for all-cause mortality, respectively.

Those patients who received BP-lowering therapy during the UKPDS trial showed no 'legacy effect' and analysis of results suggested that the difference had gone after two years.

Researchers said the findings suggest that changes to usual care guidelines after announcement of the UKPDS results in 1997 were working, and that BP-lowering treatments have their maximal beneficial effect early.

Professor Rury Holman, of the Diabetes Trials Unit at Oxford University and one of the investigators, said the results show that 'if you treat diabetes early, you see extended benefits. These data recommend you start treatment with medication rather than lifestyle advice.'


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