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. 2003 Nov;96(11):833-6.
doi: 10.1093/qjmed/hcg143.

Intensified treatment of type 2 diabetes--positive effects on blood pressure, but not glycaemic control

G V Gill  1 , A Woodward, S Pradhan, M Wallymahmed, T Groves, P English, J P Wilding
Affiliations

Intensified treatment of type 2 diabetes--positive effects on blood pressure, but not glycaemic control

G V Gill et al. QJM. 2003 Nov.

Abstract

Background: Since publication of the UK Prospective Diabetes Study (UKPDS) in 1998, there has been a clear evidence base for tight glycaemic (HBA(1c) < 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 HBA(1c)), 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 HbA(1c) 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.

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