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)
