Treating multiple risk factors is additive
Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes
Steno-2 -StudyToday we will look at the goals and imperfect results achieved. Yesterday we looked at the benefits of these people just given the opportunity to just do their best .
Treatment goals baseline test results at 7.8 years results at 13 years
( intensive treatment ended) ( continued observation ended )
(intensive ) (conventional) (intensive ) ( conventional )
A1c < 6.5 8.4 to 8.7 7. 5 9 7.8 8
Systolic BP <130 147mmhg 131 146 140 146
Diastolic BP <80 85 73 78 74 73
cholesterol <200 205- 224 150 202 175 175
LDL Chol. <70 115 - 132 80 132 75 80
Triglycerides <150 200 - 270 150 260 150 150
waist size
men <40 inches 41 42. 5 44 44 43
women <35 inches 39 42 42 44 45
Losing weigh and reducing waist circumference failed for almost everyone in both groups.
Achieving an A1c of < 6.5 was successful in about 18% of the intensive treatment and 10% of the conventional treatment patients.
There is little doubt that managing food and trying to correct our blood sugars to target goals, while avoiding low blood sugars, consumes the bulk of time spent dealing with this disease each day . This also means that many of us will fall short of the recommended goals. Don't be discouraged , just do your best .
Effort Counts
This study demonstrates the value of our imperfect efforts controlling blood glucose combined with the easer task of taking " statins " and blood pressure pills will reduce the risk developing small and large vessel disease.
This study also confirms long term followup finding in the of the UKPDS and DCCT studies ;
a period of intensive control of glucose has a lingering long term effect in reducing the risk of all diabetes complications including cardiovascular disease. More on this tomorrow.
Have Fun , Be smart and just do your best
David Calder,MD
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Your comments and questions are appreciated. David Calder,MD