Chapter 15. Does Tight Control of Hyperglycaemia Limit Mortality in Type 2 Diabetes?: A Commentary

  1. R. Williams2,
  2. W. Herman3,
  3. A.-L. Kinmonth5 and
  4. N. J. Wareham4
  1. R. John Jarrett

Published Online: 9 APR 2003

DOI: 10.1002/0470846585.ch15

The Evidence Base for Diabetes Care

The Evidence Base for Diabetes Care

How to Cite

Jarrett, R. J. (2002) Does Tight Control of Hyperglycaemia Limit Mortality in Type 2 Diabetes?: A Commentary, in The Evidence Base for Diabetes Care (eds R. Williams, W. Herman, A.-L. Kinmonth and N. J. Wareham), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/0470846585.ch15

Editor Information

  1. 2

    Nuffield Institute for Health, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK

  2. 3

    Department of Internal Medicine and Epidemiology, 1500 East Medical Center Drive, 3920 Taubman Center, Box 0345, Ann Arbor, MI 48109, USA

  3. 4

    Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

  4. 5

    General Practice and Primary Care Research Unit, Dept. of Public Health & Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

Author Information

  1. 45 Bishopsthorpe Road, London SE26 4PA, UK

Publication History

  1. Published Online: 9 APR 2003
  2. Published Print: 27 AUG 2002

ISBN Information

Print ISBN: 9780471988762

Online ISBN: 9780470846582

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Keywords:

  • glycaemia;
  • cardiovascular disease;
  • glucose intolerance;
  • hypoglycaemic therapy;
  • microvascular disease;
  • secondary prevention

Summary

Dr Adler's chapter clearly demonstrates an association between glycaemia – measured in various ways – and cardiovascular disease events both in cross-sectional and prospective studies. Despite potential biological pathways to explain the association, it remains debatable whether glucose really is a determinant or whether the association is due to confounding. There are several reasons to suspect disease with glucose intolerance and the unimpressive effects of hypoglycaemic therapy in preventing cardiovascular events. The first major attempt to study therapy, the University Group Diabetes Program, failed to find any difference between a group intensively treated with insulin and two other groups treated with standard doses of insulin or with a placebo, respectively. In the UKPDS, though events were less common in the intensively treated groups, by intention to treat analyses there were no significant differences from controls in any of the individual endpoints. It is suggested that the debate has become academic given that glycaemic control is desirable to control microvascular disease, while other forms of therapy have proved to be very effective, at least in the secondary prevention of cardiovascular disease.