The Legacy Effect: Timing counts in type 2 diabetes – control early to prevent disease and death.

The United Kingdom Prospective Diabetes Study began in 1997. Little did they know that a twist in their plans would result in some surprising findings a few years later.

by James Hubbard, M.D., M.P.H.

Long-term complications of type 2 diabetes can be numerous and severe.  How can you best decrease these?

Treat it hard, fast and early says a new NEJM study, online since September 10, 2008.  Details follow, but the bottom line is, get your sugar under control ASAP after being diagnosed and you will decrease serious complications, even risk of death down the road.   Diet, exercise, oral medicines and insulin, whatever it takes.

Study Details

Before starting this study, called The United Kingdom Prospective Diabetes Study (UKPDS), newly diagnosed diabetics with fasting blood sugars (FBS) greater than 108 were treated with diet for three months.  If their FBS continued over 108 but less than 270, they were randomized into three groups. In the investigators’ words, group 1 got “conventional therapy” while groups 2 and 3 got “intensive therapy.”

  • Group 1 managed diabetes by diet alone.
  • Group 2 added a sulfonylurea (a standard medicine) or insulin.
  • Group 3 involved people initially randomly chosen for group 2 but who were overweight. They received metformin (another standard oral treatment).

In September 1998, one year after the study began, another study threw a wrench into this one’s plans. That study showed that it was essential for type 2 diabetics to keep their sugar under strict control to decrease complications

At that point, the UKPDS released the treatment groups to take whatever measures needed to get glucose control, but the researchers still checked the participants periodically, with lab, blood pressures, etc., for five years.  They monitored them by questionnaires for another five years.

Surprising Findings

During the one initial year of treatment within the study, groups 2 and 3 had better glucose control than group 1.  After everyone was released to the best treatment, all groups obtained the same level of control. Despite this, definite differences in outcomes developed.

After the study’s 10-year completion, group 2 showed 25-percent less kidney and eye disease (microvascular disease), 15-percent fewer heart attacks and 13-percent fewer overall deaths than group 1.  Group 3 fared even better, with 26 percent less microvascular disease, 39 percent fewer heart attacks and 36 percent fewer overall deaths.

The benefits of starting early with aggressive treatment and control has been called the “legacy effect” of diabetes.  How it works remains unclear and is still being studied.

But the lesson: Check your sugar as recommended by your doctor.

What It Means to You

Catch diabetes as early as possible and don’t dilly-dally with treatment.  Risk factors for type 2 diabetes include family history and being overweight.  Symptoms include fatigue, increased urination or thirst and urinating frequently after bedtime.  Hemoglobin A1C (glycolated hemaglobin) is a blood test that measures what your average blood sugar has been for the two to three months preceding the test. It’s an excellent way to monitor your glucose control.  Keep the HA1C at 7, give or take a few tenths.

What Friends Can Do

If you don’t have it yourself, almost everyone knows someone with diabetes.  Diabetics need willpower and incentives to keep glucose tightly controlled.  Show them this study.  They need your support and understanding.  Help them comply with doctors appointments and treatments.  Don’t tempt them with snacks with that, “This one time won’t hurt,” line. Let them decide.  Maybe you could exercise together.

Has anyone had experience with treatments or compications of diabetes?

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6 Responses to “The Legacy Effect: Timing counts in type 2 diabetes – control early to prevent disease and death.”

  1. DR Says:

    The inflammatory effects of high blood sugar / high insulin levels have long term effects on the body.

    But like high blood pressure, we don’t “see” what is happening on the inside.

    So, we avoid the warning signs until they progress to the point where we can’t ignore them.

    It’s just another example of how an ounce of prevention is worth a pound of cure.

    DRs last blog post..Is Your Diet Giving You Alzheimer’s Disease?

  2. Miz Liz Says:

    Another great data set from UKPDS. Very important for prevention and totally necessary to get the word out.


  3. M Says:

    A friends father was diagnosed the past year with diabetes. A very unhealthy lifestyle was the contributing factor. Excellent information! Thanks as always!

    Ms last blog post..Stock Market’s Down–So’s My Scale! Yessss!

  4. James Hubbard, M.D., M.P.H. Says:

    Thanks DR
    You are so right. From this study, catching it very early is very worthwhile.

  5. James Hubbard, M.D., M.P.H. Says:

    Miz Liz,

    I agree and I don’t think the word is out. I certainly did not know that it would make that much difference to wait and try to get the Glucose down with diet alone. I will start being a little more aggresive on medications.

  6. James Hubbard Says:

    Thanks for the comment, Mark. Lifestyle can cause type 2 diabetes, or tip you over the edge. A healthy diet, exercise, not smoking is a big part of the cure also.

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