Intensified treatment of type 2 diabetes--positive effects on blood pressure, but not glycaemic control.
BACKGROUND
Since publication of the UK Prospective Diabetes Study (UKPDS) in 1998, there has been a clear evidence base for tight glycaemic (HBA(1c) < 7.0%) and blood pressure (BP < 140/85 mmHg) control.


OBJECTIVE
To determine the effect of UKPDS-based intensified glycaemic and BP targets on the care of type 2 diabetic patients attending a routine diabetes clinic.


METHODS
Two surveys, each of 500 consecutively attending type 2 diabetic patients.


METHODS
The first survey was in a 3-month period in 1999, shortly after publication of the UKPDS study. The second was identical, but 2 years later. Glycaemic control (by DCCT-aligned HBA(1c)), BP and treatment details were recorded in both.


RESULTS
BP control was significantly improved in the second survey (mean +/- SD systolic BP from 151 +/- 25 to 146 +/- 26 mmHg, p = 0.001; diastolic from 77 +/- 13 to 72 +/- 12 mmHg, p < 0.0001) and the proportion of patients on anti-hypertensive treatment increased from 33% to 60% (p < 0.0001). Mean HbA(1c) however remained unchanged (8.7 +/- 1.8% in 1999 vs. 8.5 +/- 1.8% in 2001), although there was evidence of more intensive treatment patterns, with declining numbers on diet alone and more on oral agents and/or insulin.


CONCLUSIONS
Intensified BP control may be achievable within the confines of routine diabetes care, but achievement of optimal glycaemic targets remains problematic.
Gill
G V
GV
Department of Diabetes and Endocrinology, University Hospital Aintree, Liverpool, UK. g.gill@liv.ac.uk
Woodward
A
A
Pradhan
S
S
Wallymahmed
M
M
Groves
T
T
English
P
P
Wilding
J P
JP
D000284:Administration, Oral; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis*; D001794:Blood Pressure / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000503:physiopathology; D004032:Diet; D004359:Drug Therapy, Combination; D005260:Female; D006306:Health Surveys; D006441:Hemoglobin A / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged
D000959:Antihypertensive Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D006441:Hemoglobin A