How many benefits does diabetes have? 10-year follow-up results published in the lancet

"By early detection and treatment through screening, diabetic patients can achieve continuous improvement of blood glucose and related cardiovascular risk factors for more than 10 years." Diabetic patients are often accompanied by hypertension, dyslipidemia and other important risk factors of cardiovascular and cerebrovascular diseases For type 2 diabetic patients, especially those with long course, old age and cardiovascular disease history, it is not enough to rely on strict blood glucose control Comprehensive control of multiple risk factors can help significantly prevent cardiovascular and cerebrovascular disease and related deaths However, the existing large-scale research is mainly based on the research of "old sugar friend" If we carry out multi factor intensive treatment in the early stage of the disease, is it necessary, and what is the effect? This is the answer to a large study called adition Europe, which began in 2001 Recently, the latest analysis of the study's 10-year tracking was published in the lancet dialogues & Endocrinology Screenshot source: The Lancet dialogues & Endocrinology website During the period from April 2001 to December 2006, 343 general practitioners from the UK, Denmark and the Netherlands were randomly divided into four regions 3057 newly diagnosed type 2 diabetes patients aged 40-69 years were treated with routine treatment or multi factor intensive treatment, the latter included the management of blood glucose, blood pressure and blood fat, and provided the support of concept education and lifestyle change After the first 5 years of intervention, the patients who received multifactor intensive treatment took slightly more drugs than those in the regular treatment group, and the risk of cardiovascular events was 17% lower, but the difference was not significant enough Since then, the team has not continued to intervene to artificially maintain differences between the two groups In general, HbA1c, blood pressure, cholesterol and body weight of the two groups improved continuously during the 10 years of diagnosis and treatment For example, systolic blood pressure was controlled at about 135 mm Hg and total cholesterol was controlled below 4.5 mmol / L However, compared with 5 years after treatment, 10 years after treatment, the gap between groups was narrowed In the past 10 years, HbA1c, blood pressure, blood glucose and blood lipid of the two groups were improved continuously, but the advantage of the multi factor intensive treatment group (red line) was gradually reduced (image source: reference [1]) Ten years later, 433 people experienced cardiovascular events for the first time, including myocardial infarction, stroke, revascularization and amputation or death due to cardiovascular disease, with a total of 465 deaths from all causes The incidence of cardiovascular events was 14.3 cases / 1000 person year and 16.1 cases / 1000 person year respectively in the multi factor intensive treatment group and the conventional treatment group The risk of cardiovascular events was 13% lower in the multi factor intensive treatment group and 10% lower in the all-cause death group, but the difference was still not significant But further analysis found that the difference in cardiovascular risk was more significant in patients aged 60 and over There was no hypoglycemia related death in either group and no difference in renal health (proteinuria) ▲ after 10 years, the risk of cardiovascular events was reduced by 13% in the MPT group, but there was no significant difference between the two groups (picture source: reference [1]) First of all, early detection and treatment through screening, diabetes patients can achieve more than 10 years of continuous improvement of blood glucose and related cardiovascular risk factors Secondly, in the aspect of multi factor intensive treatment, although the effect observed in this study is weaker than that in the study of long-term patients, the more obvious improvement of cardiovascular risk in the elderly still suggests that the long-term effect of multi factor intensive treatment of risk factors in the early stage of diabetes is expected, and the 10-year observation period may not be enough to make this effect fully show Now In conclusion, patients with type 2 diabetes can benefit from early detection and comprehensive treatment of multiple risk factors According to the editorial published at the same time, combined with many large-scale researches in the field of diabetes, we can see the progress in diabetes treatment in recent decades It is feasible to carry out multi factor intensive treatment for type 2 diabetes in practice and may help prevent cardiovascular events For example, compared with the famous UK Prospective Diabetes Study (UKPDS), which started in the 1970s, the incidence of myocardial infarction and stroke, as well as cardiovascular mortality, are lower in this addition Europe study, even in the conventional treatment group, although the proportion of patients with a history of cardiovascular disease is higher and the age is generally larger At the same time, the editorial pointed out that in the next study, it is very important to continue to observe whether the benefits of multifactor intensive treatment will become more and more obvious, or gradually disappear; in more 10-year follow-up, it is also very important to track these patients' diabetes complications and mortality Because such research is rare, these data will be very valuable to help us understand more deeply that the long-term effects of blood glucose and other risk factors are well controlled in the early stage of the disease Reference material [1] Simon J Griffin, et al., (2019) Long-term effects of intensive multifactorial therapy in individuals with screen-detected type 2 diabetes in primary care: 10-year follow-up of the ADDITION-Europe cluster-randomised trial The Lancet Diabetes & Endocrinology, 10.1016/S2213-8587(19)30349-3