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| |  Drugs More Effective Than Diet To Maintain Blood Sugar In Type II Diabetics CHICAGO, IL -- June 1, 1999 -- Over the course of type II diabetes mellitus (adult-onset non-insulin-dependent diabetes) a combination of therapies is necessary to successfully maintain target blood glucose (blood sugar) levels, according to an article in tomorrow’s issue of The Journal of the American Medical Association. Robert Turner, F.R.C.P., of Radcliffe Infirmary in Oxford, England, and colleagues reporting for the U.K. Prospective Diabetes Study (UKPDS) Group analysed the proportion of 4,075 patients newly diagnosed as having type II diabetes mellitus who were able to achieve glycemic control (maintain the targeted blood glucose levels) using various therapies. The study used blood glucose target levels set by the American Diabetes Association: a fasting plasma glucose (FPG) level less than 140 mg/dl (7.8 mmol/L) or glycosylated hemoglobin A1c (HbA1c) below seven percent. While FPG provides a snapshot of a patient’s blood glucose levels at the time of testing, HbA1c can be used to give a retrospective look at a patient’s glucose control over time. The researchers found that the majority of the patients studied need multiple therapies to attain and maintain these targeted blood glucose levels in the long term. When compared to using diet alone as a therapy, the other therapies used alone more than doubled the proportion of patients who attained target blood glucose levels. "Each therapeutic agent, as monotherapy, increased two- to three-fold the proportion of patients who attained HbA1c below seven percent compared with diet alone," the authors write. "However, the progressive deterioration of diabetes control was such that after three years approximately 50 percent of patients could attain this goal with monotherapy and by nine years this declined to approximately 25 percent. The majority of patients need multiple therapies to attain these glycemic target levels in the longer term." After three months on a low-fat, high-carbohydrate, high-fibre diet, patients were randomly assigned to receive therapy with diet alone, insulin or sulfonylurea. Some patients determined to be obese were randomly assigned to receive metformin. (Both sulfonylurea and metformin are hypoglycaemic agents - drugs used to lower levels of glucose in the blood.) The patients were then followed up every three months for three, six and nine years after being enrolled in the study. The proportion of patients who were able to maintain target glycemic levels declined markedly over the nine years of follow-up. The proportion of patients (randomly assigned to the different monotherapies) who maintained their target blood glucose levels after nine years of follow-up: diet only - eight percent achieved target FPG levels and nine percent achieved target HbA1c levels; insulin only - 42 percent achieved target FPG levels and 28 percent achieved target HbA1c levels; sulfonylurea only - 24 percent achieved target FPG levels and 24 percent achieved target HbA1c levels. Of those patients determined to be obese (more than 20 percent above their ideal weight) randomly assigned to monotherapy with metformin, 18 percent achieved target FPG levels and 13 percent achieved target HbA1c levels after nine years of follow-up. In the study overall, patients who were less likely to achieve target blood glucose levels were younger, more obese or more hyperglycaemic (had abnormally high concentrations of glucose in their blood) than the other patients in the study. "One of the main goals of treating patients with type II diabetes mellitus is to produce near-normal glucose levels to prevent the development of diabetic complications," the authors note. By controlling blood glucose levels, the microvascular complications associated with diabetes, such as retinopathy, can be delayed, according to the authors. "It is apparent by nine years after diagnosis that even with this combination of oral agents a substantial number, possibly the majority, of patients will need the addition of insulin therapy to obtain an HbA1c level below seven percent," the authors write. "Since improved glucose control with insulin therapy is known to reduce the risk of diabetes complications, the progressive decline in beta-cell function with greater hyperglycemia will require considerably greater use of insulin therapy than that currently prescribed."
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