Q J Med 2003; 96: 833-836
© 2003 Association of Physicians
Intensified treatment of type 2 diabetes—positive effects on blood pressure, but not glycaemic control
From the Department of Diabetes and Endocrinology, University Hospital Aintree, Liverpool, UK
Received 9 April 2003 and in revised form 21 May 2003
Background: Since publication of the UK Prospective Diabetes Study (UKPDS) in 1998, there has been a clear evidence base for tight glycaemic (HBA1c < 7.0%) and blood pressure (BP < 140/85 mmHg) control.
Aim: 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.
Design: 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 HBA1c), 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 HbA1c 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.
Discussion: Intensified BP control may be achievable within the confines of routine diabetes care, but achievement of optimal glycaemic targets remains problematic.
Address correspondence to: Dr G.V. Gill, Department of Diabetes and Endocrinology, University Hospital Aintree, Liverpool L9 1AE. e-mail: g.gill{at}liv.ac.uk