Chapter 29. Can Established Diabetic Complications Be Reversed? The Evidence for Secondary Prevention

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

Published Online: 9 APR 2003

DOI: 10.1002/0470846585.ch29

The Evidence Base for Diabetes Care

The Evidence Base for Diabetes Care

How to Cite

Shaw, K. (2002) Can Established Diabetic Complications Be Reversed? The Evidence for Secondary Prevention, 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.ch29

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. Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, 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:

  • hyperglycaemia;
  • foot disease;
  • nephropathy;
  • retinopathy;
  • macrovascular disease;
  • dyslipidaemia;
  • hypertension;
  • DCCT;
  • advanced glycation end-product;
  • UKPDS

Summary

Prevention of long-term complications is a major consideration in the management of diabetes. Such complications are not inevitable and great advances have been made in their primary prevention, but many people do still develop such complications which often progress inexorably. Can this progression be contained or could these complications be reversed? Treatments depend on the particular complication and its causative factors. Hyperglycaemia is an independent risk factor but restoration of normoglycaemia by pancreas transplantation has not unequivocally reversed established complications. The Diabetes Control and Complications Trial showed that the progression of established complications could be reduced by intensive treatment but the reduction was less than that achieved with the primary prevention cohort. Intervention as early as possible may be important in securing good long-term outcomes. Individual complications reviewed here are diabetic foot disease, diabetic nephropathy, retinopathy, macrovascular disease, dyslipidaemia and hypertension.