The largest-ever study of diabetes treatments has found that a fixed combination of two blood-pressure-lowering drugs reduces the risk of heart and kidney diseases, and death among patients. Results from the ADVANCE (Action in Diabetes and Vascular Disease) Study were presented on Sunday at the European Congress of Cardiology in Vienna.
Different from previous treatment strategies which only address symptoms like high blood sugar, the new study is directed at diabetes risk-control.
"These results represent an important step forward in healthcare for the millions of people with diabetes worldwide," says Professor Stephen MacMahon, of The George Institute for International Health in Australia. "This treatment reduced the likelihood of dying from the complications of diabetes by almost one-fifth, with virtually no side-effects."
A total of 11,140 patients with diabetes from 20 countries, including about 3,300 patients from China, participated in the four-year project. Half received daily treatments of a single tablet containing a fixed-combination of two blood-pressure-lowering drugs, and half were given a matching, inactive placebo.
According to the results, the combination of blood-pressure-lowering medicines could reduce the risk of death from any cause by 14 percent and the risk of death from cardiovascular disease by 18 percent.
The treatments were also found to reduce the risk of coronary-heart-disease events by 14 percent, and the risk of new or worsening kidney disease was reduced by 21 percent.
According to the 2002 National Nutrition and Health Survey, an estimated 27 million Chinese are diabetic. Experts believe that the rapid urbanization of the country and consequential lifestyle changes place it at risk of becoming a high-incidence region in the future.
Currently, about 250 million people are living with diabetes worldwide - most of whom will eventually die or be disabled by complications caused by their condition. Among diabetics, the most common cause of death is heart disease, followed by kidney disease.
In 2006, the United Nations issued a statement calling for increased international action to combat the global epidemic of diabetes.
"As the largest clinical trial ever performed on patients with Type 2 diabetes, the ADVANCE study is an important trial in seeking a new clinical strategy for dealing with Type 2 diabetes," says director of The George Institute, China, professor Wu Yangfeng.
"Different from any previous treatment strategies, which only addressed the clinical symptoms occurring in diabetes patients, such as high blood sugar, high blood fat and hypertension, this study is directed at diabetes risk-control, which has proved to be another effective tool in reducing the harmful effects of diabetes."
Nearly 40 percent of the participants in the ADVANCE study were diabetes patients with normal blood pressure. But according to Wu, they have a higher risk of developing hypertension compared to the healthy group. The study suggests that containing the hidden risks of diabetes, such as hypertension early on, could significantly reduce the risk of complications, Wu says.
Wu warns that using blood-pressure-lowering drugs on diabetes patients had been a very carefully considered clinical treatment option, because these medications could cause side-effects. Using a combination of two drugs in small doses, as applied in the study, proved that these medications could offset each other's side-effects.
"The results clearly demonstrate that we have the tools to blunt the impact of the global diabetes epidemic facing rich and poor countries alike," says Professor John Chalmers, author of previous international guidelines for the treatment of high blood pressure.
"But concerted action is urgently required to ensure that patients with diabetes are identified and provided with treatments proven to improve important outcomes, like survival."
According to Wu, one of the major problems with current diabetes treatment is that most doctors lack a comprehensive perspective in diabetes treatment. For example, when a patient is sent to the diabetes department, most doctors only prescribe blood-sugar-reducing drugs and do not consider other risk factors, such as blood pressure and blood fat, which they believe the cardiologists are responsible for.
(China Daily September 5, 2007)
