Friday, August 17, 2012

"Opportunity " to just do your best is successful in diabetes care


Treating multiple risk factors is additive

Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes
Steno-2 -Study
N. England Journal of Med. 2008:358:580-591

Today 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