Type 2 diabetes towards the new millennium--the relative importance of glycaemic versus lipid control.
The prevalence of type 2 diabetes is set to increase. The UKPDS has shown that better average glycaemic control over time leads to a reduction in microvascular complications. Macrovascular outcomes are also reduced in overweight subjects treated with metformin. The UKPDS and our own data, however, show that the natural history of type 2 diabetes is one of progressive deterioration in glycaemic control despite treatment. Lipid parameters emerges as the strongest predictors of outcomes in type 2 diabetes and suggest where therapeutic endeavours might best be directed. Ongoing trials of lipid-modifying therapies in type 2 diabetes will help to substantiate this. In the meantime, efforts to improve glycaemic control should not be pursued to the exclusion of other abnormalities that may have a greater relevance to outcomes of type 2 diabetes. There is an urgent need for better prevention and intervention strategies as we approach the new millennium.
Florkowski
C M
CM
Lipid and Diabetes Research Group, Christchurch Hospital, New Zealand.
Scott
R S
RS
D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D009520:New Zealand / Q000453:epidemiology
D001786:Blood Glucose; D007004:Hypoglycemic Agents