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Speciality Spotlight
Diabetes
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R Turner, for the UK Prospective Diabetes Study Group (Radcliffe Infirmary, Oxford, England)
Tight Blood Pressure Control and Risk of Macrovascular and Microvascular Complications in Type 2 Diabetes: UKPDS 38.
Bmj 317: 703-713, 1998.
Hypertensive patients were either put under tight control or not so tight control of their high B.P. Patients whose blood pressures were reduced to below 144/82 mm Hg were considered to be under tight control. As compared with those patients whose blood pressures reduced to only 154/87 mm Hg or more, there were great differences in prognosis. In the tight blood pressure control group, there was 24% reduction in the risk in diabetes-related end points.
Editors comment: It is possible that the benefit of treatment with ACE inhibitors of diabetic nephropathy is more due to tight control of blood pressure which is achieved by addition of ACE inhibitors than the ACE inhibitors itself.
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Hannele Yki-Jarvinen (Dept. of Medicine, Univ. of Helsinki, Helsinki, Finland)
Management of Type 2 Diabetes Mellitus and Cardiovascular Risk
Drugs Nov.2000; 60(5)p. 975-983
Very often NIDDM (type 2 diabetes) is associated with hypertension. The disease carries increased risk of microvascular and macrovascular complications. It has now been shown that treatment of hyperglycemia is very effective in reducing microvascular disease but is not so effective in reducing macrovascular disease such as myocardial infarction, stroke and diabetic foot. The authors postulate that prevention of macrovascular disease is much more effectively treated by controlling hypertension, hypercholesterolaemia and small doses of aspirin.
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Skyler JS, Cefalu WT, Kourides IA, et al
Efficacy of Inhaled Insulin Type I Diabetes Mellitus: A Randomized Proof-of-Concept Study
Lancet 357: 331-335, 2001
The authors suggest once daily injection of long acting insulin and three preprandial insulin inhalations, gave as good a control as two or three injection of insulin, in Type I diabetes.
