Diabetes doctors debate the best diagnostic tests

One new conclusion from the trial is that the time when treatment is begun is crucial, Dr. William C. Duckworth of the Carl T. Hayden VA Medical Center in Phoenix told the meeting. Aggressive treatment begun during the first 15 years after diagnosis is beneficial, while beginning such treatment between 15 and 20 years after diagnosis provides little or no benefit, the team found.

Surprisingly, beginning aggressive treatment 20 years after diagnosis was associated with a doubled risk of heart attacks and strokes, for reasons that are not clear.

Like ACCORD, the VADT team observed an association between hypoglycemic events and the risk of death. But they observed three times as many severe hypoglycemic events in the aggressive treatment arm, suggesting a need for careful control of medications to avoid such extremes.

Researchers are at a loss to explain the differences between the two studies. One possibility is that it is related to the drugs that were used. But physicians prescribed whatever medications they thought were appropriate, so teasing out effects will be difficult.

One conclusion comes out of both trials, however, Duckworth said: "We have to treat early and carefully."

--

thomas.maugh@latimes.com