The results generated from several drug intervention trials in recent years were influencing diabetes therapy, said Dr Gunnar Valtysson (consultant endocrinologist, University of Iceland).
The US diabetes control and complications trial (DCCT) in type 1 diabetes and the United Kingdom prospective diabetes study (UKPDS) in type 2 diabetes patients showed that intensive glycaemic control was associated with a highly significant reduction in long term diabetic complications, he said. Dr Valtysson added that the UKPDS triallists also concluded that tight control of blood pressure in diabetes patients, using atenolol and captopril, resulted in a marked reduction in retinopathy (37 per cent), diabetes related mortality (32 per cent) and stroke (40 per cent).
The Scandinavian simvastatin survival study had shown a significant reduction in coronary events in diabetes patients treated with cholesterol lowering agents, said Dr Valtysson. This had led to the recommendation of aggressive dislipidaemia therapy for type 2 diabetes using almost the same criteria as for coronary heart disease patients without diabetes, he added. New therapeutic agents for diabetes treatment had emerged in recent years, continued Dr Valtysson. The new insulin analogues were capable of improving therapy, he said, and inhaled human insulin would probably be on the market within one or two years. Personal blood glucose monitoring had been a major step for diabetes patients, said Dr Valtysson, and the development of a new non-invasive technique applying electrophoresis brought with it great expectations.
Responding to a question about the use of aggressive therapy in patients who were often elderly, Dr Valtysson said that physicians needed to take into account the condition of an individual but pointed out that there were now many relatively young type 2 diabetes patients, even children, due to the marked increase in body weight seen in the western world. In these younger individuals it was important to use intensive, multi-drug treatment to prevent the onset of diabetic complications.
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Dr Valtysson: aggresive therapy needed
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