Those who lowered their blood pressure and "bad" LDL cholesterol, raised their "good" HDL cholesterol, exercised regularly, avoided smoking and took the proper medications had almost half the risk of a heart attack, stroke or other cardiovascular problems as those who had less intensive medical care, the study says. It appears in the Jan. 30 issue of The New England Journal of Medicine.
Since all these measures are known to reduce risk, why do such a study?
"This study was started 10 years ago, and at that time there was no evidence that people with Type II diabetes would benefit from treatment at all," says study leader Dr. Oluf Pedersen, director of the Steno Diabetes Center in Copenhagen. "Diabetes treaters were indifferent and uncertain about the outcome."
In addition, Pedersen says, while there have been many studies evaluating the effect of individual risk-reducing measures -- lowering blood pressure or cholesterol, promoting exercise, abstaining from smoking -- "nobody has previously evaluated the total impact of integrated treatment of Type II diabetes."
Type II diabetes happens when the body cannot produce enough insulin or uses it improperly. It was once called adult-onset diabetes, but doctors are finding it in children more and more. It is by far the most common form of diabetes.
The eight-year study assigned 80 patients with Type II diabetes to conventional care and another 80 to intensive care designed to meet specific goals for a number of risk factors -- for example, keeping blood pressure below 130/80 and keeping LDL cholesterol below 100 milligrams per deciliter. People in the intensive care group were also advised to take a dietary supplement that included vitamins E and C and folic acid, and they were given an ACE inhibitor drug to prevent kidney disease. After nearly eight years, 24 percent of those in the intensive care group had a major cardiovascular event (heart attack, stroke or the like), compared to 44 percent of those getting conventional treatment, the report says.
"We were not hoping for so great an impact," Pedersen says, based on the results of studies of individual risk factors. "It is important to have this kind of evaluation. Most national health experts recommend this kind of treatment, but its effects have never been evaluated."
The study results are "reaffirming the things we pretty much do," says Dr. Eugene J. Barrett, a professor of medicine at the University of Virginia and president-elect of the American Diabetes Association. "There's nothing startling here. It says that if you pay attention to each of the cardiovascular risk factors, you will have a major effect on the clinical outcome."
However, what is possible in a small study is not always achievable in everyday practice, Barrett acknowledges. "The issue with any set of practice guidelines is what people recognize as optimum and what can be done in the real world."
Both physicians and patients must work to put the recommended preventive measures into action, Barrett says.
Learn how to prevent heart complications from the Joslin Diabetes Center or the National Institute of Diabetes and Digestive and Kidney Diseases.