Tight Blood Sugar Control Helps Diabetics Long-Term

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Holman's team found that, overall, patients who had initially received intensive blood sugar control with metformin during the 10 years of the trial had a 21 percent reduction in microvascular disease, heart attack, and all-cause mortality during the post-trial 5-year period -- when many had adopted less stringent blood sugar control. In fact, these patients reduced their long-term risk of heart attack by 33 percent, the team found. Their overall risk of death was also reduced by 27 percent, compared to patients who had not entered into medicinal blood sugar control during the trial.

"There was no significant change during or after the trial with respect to microvascular disease," Holman added. However, among patients receiving insulin, there was a 24 percent reduction in microvascular disease.

The bottom line: Strict control of blood sugar appears to have healthful effects that last long after such strategies end, the team found.

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Would similar results arise for the control of blood pressure? In their second study, Holman's team randomly assigned more than 1,100 type 2 diabetics with high blood pressure to tight or moderate blood pressure control regimens for a four-year period. After that initial phase, the participants were asked to check in with doctors at annual clinics, but no attempt was made by the researchers to maintain each patient's assigned treatment.

The result: Any difference in blood pressure between the two groups (tight or moderate blood pressure control) disappeared two years after the trial ended, and patients lapsed back into less-than-optimum blood pressure control.

"Any diabetes-related endpoint -- such as diabetes-related death or stroke and microvascular disease -- were not maintained following the loss of within-trial blood pressure and antihypertensive therapy differences," Holman said. "No significant changes were seen during or after the trial with respect to [heart attack] or all-cause mortality," he said.

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