[TomB]

These 2 articles were printed in the October 9, 2008 issue of The New England Journal of Medicine.

1. Long-Term Follow-up after Tight Control of Blood Pressure in Type 2 Diabetes

NEJM -- Long-Term Follow-up after Tight Control of Blood Pressure in Type 2 Diabetes

Conclusions
The benefits of previously improved blood-pressure control were not sustained when between-group differences in blood pressure were lost. Early improvement in blood-pressure control in patients with both type 2 diabetes and hypertension was associated with a reduced risk of complications, but it appears that good blood-pressure control must be continued if the benefits are to be maintained.

My take: this studied showed that if you have high blood pressure, getting it down and keeping it down reduces the risk of developing PAD.

2. 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes

NEJM -- 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes

Conclusions
Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients.

My take: get that A1c down to a normal level to reduce long term risk of blocked arteries.

Previous studies in the USA indicate that a gradual, not rapid, reduction in A1c resulted in a substantial risk reduction for MI, CAD, PAD, etc. These studies show that those benefits continue for a long term.

These studies are necessary because governments and insurance companies do not base decisions on opinions. They must have hard facts and data. So good, now they have the facts and data to show that treating diabetes long term is a lot cheaper than treating its complications like a heart attack or CAD, PAD or screwed up kidneys. Now I wonder how long it will take for them to act.

[REDLAN]

I find this a rather strange study. What it didn't show was

So good, now they have the facts and data to show that treating diabetes long term is a lot cheaper than treating its complications like a heart attack or CAD, PAD or screwed up kidneys.

They followed up a group of patients from the UKPDS trial. We don't know how many exactly because it doesn't say in the abstract. They were divided into intention to treat categories, because as the study concludes

no attempts were made to maintain their previously assigned therapies

they noted that

Between-group differences in glycated hemoglobin levels were lost after the first year

So they all ended up with similar levels of control for 5 years.

Their study found that 5 years further down the line, there were still some small relative risk reductions that persisted.

interestingly the metformin group showed a significant reduction for myocardial infarction. The reduction in the original study was found not to be signficant.

cynically it actually shows that...

you only need to treat someone for 5 years, and then you can stop bothering to treat their BG and they will still benefit.

The real question here is...

How does metformin produce a lingering benefit after treatment is stopped?

They did not find this with treatment of hypertension. Once hypertensive treatments were stopped the benefits disappeared. Which is what you'd expect.

[Relative Risk Reductions - the risk reductions in the study are fairly modest. Without additional data it is impossible to calculate a Number Needed to Treat (NNT). The NNT is the most significant number as far as the patient is concerned as it tells you how likely it is that the treatment will work. The original UKPDS study had NNT's in the 50's. What this actually means in reality is that something that is clinically significant is not necessarily significant for the patient]

[BlueSky]

Originally Posted by REDLAN

... Once hypertensive treatments were stopped the benefits disappeared. ....

But they went on to say that there continued to be reduced risk of PAD.

... Differences in blood pressure between the two groups during the trial disappeared within 2 years after termination of the trial. ... but a risk reduction for peripheral vascular disease associated with tight blood-pressure control became significant (P=0.02). ...

It seems like a bit of a contradiction.