Controlling glucose and blood pressure in type 2 diabetes

Starting treatment earlier may reduce complications

Papers pp 405, 412

Strategies for treating disorders of public health interest such as high blood pressure, dyslipidaemia, and hyperglycaemia have been debated ever since they were considered to be conditions for medical interventions. The main questions have been when should we start treatment, what is the target level during treatment, and what is the best method of treatment? Since there are no obvious cut-off points for blood pressure or glucose or cholesterol concentrations that would guide clinical decisions, the justification must come from clinical and epidemiological research.

Data from randomised clinical trials are considered necessary these days for defining treatment practice, but there are limits on the generalisability of their results.1 These results are important in proving causality between risk factors and outcomes and in showing the reversibility of the disease process by therapy. Observational data, on the other hand, are needed to describe the target population included in the trials and thus to …