Facts and Fiction about Type 2 Diabetes.ppt

Facts and Fiction about Type 2 Diabetes Michael L. Parchman, MD Department of Family Community Medicine September 2004 Complications from Type 2 Diabetes Microvascular Retinopathy Neuropathy Nephropathy Autonomic: gastroparesis, blood pressure Macrovascular MI CVA Claudication/PVD Preventing Complications from Type 2 Diabetes Glucose Blood Pressure Lipids What is the Evidence? UKPDS The only large study of patients with Type 2 DM of new onset 20 year study conducted in 23 centers in the U.K. More than 5,000 patients enrolled Primary Aim: determine the effect of intensive control of glucose on 21 predetermined end-points. Added a secondary arm to study the effect of blood pressure and lipid control. Glucose: Fact or Fiction? Tight control of blood glucose improves mortality. FACT: Tight control of blood glucose did not prevent premature mortality Glucose: Fact or Fiction? All patients with type 2 diabetes benefit from treatment with metformin. FACT: In overweight patients, metformin decreased mortality related to diabetes or other cause (13.5 v. 20.6 events per 1000 pt yrs, NNT per year=141) AND diabetes related complications (29.8 v. 43.3 events/1000 pt yrs) “Overweight patients with type 2 DM seem to benefit not so much from the overall control of glucose but rather from taking metformin.” Glucose: Fact or Fiction? Tight control of blood glucose prevents the onset of microvascular and macrovascular complications. FACT: Changes in HbA1c produced by intensive drug treatment did not correlate with microvascular or macrovascular outcomes. FACT: In overweight patients, treatment with insulin or sulfonylureas had no effect on individual or aggregate microvascular or macrovascular outcomes. BP: Fact or Fiction Tight blood pressure control prevents macrovascular but not microvascular complications FACT: Tight control of blood pressure decreased likelihood of ALL 21 different endpoints, microvascular, macrovascular and mortality. Control of BP had greater effect on compli