Population-Based Strategy for Preventing Diabetes and its Complications

Abstract

A recent report from the American College of Physicians (ACP) should cause a paradigm change for the treatment of diabetic
patients.1 The main purpose of diabetes therapy is the prevention of complications.2 The endpoint of many clinical trials is to lower
blood glucose levels, but intensive treatments aimed at lowering the HbA1c to less than 6.5% are often accompanied by hypoglycemia
as a side effect. At the same time, intensive regimens have not shown a reduction of cardiovascular complications in the longterm.
3-7 For example, the action to control cardiovascular risk in diabetes (ACCORD) trial was prematurely discontinued, following
the observation of an increase in overall mortality, cardiovascular- related deaths, and severe hypoglycemic events.3 The action in diabetes and vascular disease; preterAx and diamicroN-MR controlled evaluation (ADVANCE) study also failed to show a statistically
significant clinical benefit, while more adverse effects were seen among those who achieved a median HbA1c level of 6.4%.4 More intensive treatments with tight glycemic control targets are more costly and associated with increased patient burdens. Only
Hollan et al8 reported a long-term benefit with intensive therapy in the United Kingdom prospective diabetes study (UKPDS) after
10 years of intervention.