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Negative consequences can occur early when patients have elevated glucose

Progressive damage may occur even prior to diagnosis

elevated glucose
 

 
  • In the UKPDS, patients whose glucose tolerance was most severely impaired at the time of diagnosis had already lost 80%-85% of their β–cell function2

Early and intensive intervention may improve current and future outcomes

  • 10-year follow-up from UKPDS identified a “legacy effect” associated with more intensive treatment3
    • Long-term outcomes were significantly better in patients initially randomized to pharmacologic interventions vs patients randomized to dietary restriction only
    • Significant risk reductions were observed for any-cause mortality, diabetes-related death, and any diabetes-related endpoint
Mortality in patients comparing sulfonylurea or insulin to dietary restriction alone upon T2DM diagnosis

Mortality in overweight patients comparing metformin to dietary restriction alone upon T2DM diagnosis

*Mortality

HOMA=homeostasis model assessment; T2DM=type 2 diabetes mellitus; UKPDS=United Kingdom Prospective Diabetes Study

Study Design: Randomized, open-label, multicenter study of 4209 UKPDS patients with T2DM from 23 hospital-based clinics in the United Kingdom. Patients were randomized either to dietary restriction or to treatment with either a sulfonylurea or an insulin-based regimen, or metformin for patients who were more than 120% of their ideal weight. During 10 years of follow-up, patients were returned to community- or hospital-based care, but were seen annually for the first 5 years, and by questionnaire during years 6-10.3

Guidelines by the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) recommend healthy eating, weight control, increased physical activity, and diabetes education as a foundation for T2DM management throughout the course of treatment.4,5

 

 

When you intensify treatment in your patients with T2DM, will your next move do enough?

References:

1. Holman RR. Assessing the potential for alpha-glucosidase inhibitors in prediabetic states. Diabetes Res Clin Pract. 1998;40(Suppl):S21-S25. 2. DeFronzo RA. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58(4):773-795. 3. Holman RR, Paul SK, Bethel A, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577-1589. 4. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2016;39(Suppl 1):S1-S112. 5. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and the American College of Endocrinology on the comprehensive type 2 diabetes management algorithm—2016 executive summary. Endocr Pract. 2016;22(1):84-113.