New Hypertension Guidelines Fail to Improve Blood Pressure Control in People With Diabetes

Separate Study Finds Adolescent Pupil Size Predicts Later Complications

- ADA Publishes New Clinical Practice Recommendations -

Dec 27, 2006, 00:00 ET from American Diabetes Association

    ALEXANDRIA, Va., Dec. 27 /PRNewswire-USNewswire/ -- Despite the
 publication of increasingly aggressive guidelines for lowering blood
 pressure in people with diabetes, this condition remains substantially
 unimproved, according to a study being published in the January issue of
 Diabetes Care.
     A separate study being published in the same issue finds that small
 pupil size during adolescence may help predict diabetes-related
 complications later in life, such as retinopathy and microalbuminuria, a
 marker for both cardiovascular and kidney disease. The January issue of
 Diabetes Care also includes the American Diabetes Association's (ADA's) new
 Clinical Practice Recommendations, which are revised on an annual basis.
     Hypertension Guideline Changes Fail to Improve Control
     The blood pressure study, which compared hypertension control in people
 with and without diabetes from 1995-2005, showed that reducing blood
 pressure goals twice for people with diabetes during the past decade did
 little to improve control of this condition. The findings are consistent
 with other recent studies which showed that doctors fail to aggressively
 treat high blood pressure in people with diabetes, despite the fact that
 hypertension is a major symptom of cardiovascular disease, the leading
 killer of people with diabetes.
     In 1997, and again in 2003, the Joint National Committee on Prevention,
 Detection, Evaluation and Treatment of High Blood Pressure (JNC) lowered
 blood pressure goals for people with diabetes. They currently recommend
 that people with diabetes keep blood pressure at or below 130/80 mmHg.
     The changes, however, "did not lead to substantially better
 hypertension control for diabetics compared with non-diabetic patients,"
 the researchers concluded. "This finding is somewhat surprising considering
 the recognition of JNC guidelines as the gold standard for hypertension
 treatment, similar recommendations from other organizations such as
 American Diabetes Association, American College of Physicians, and American
 Academy of Family Physicians, and public health efforts to promote
 comprehensive diabetes care."
     Previous studies have shown that doctors intensified treatment of high
 blood pressure during as few as 12 percent of office visits when people
 with diabetes presented with this problem. High blood pressure can be
 treated through lifestyle and dietary changes as well as with numerous
 medications. Many people with diabetes also exhibit high blood pressure, an
 early warning sign for the development of heart disease.
     Identifying effective interventions to deal with the challenge of
 lowering blood pressure in people with diabetes should be a top priority
 for future research, the authors concluded.
     Small Pupil Size Predicts Complications in Adolescents
     In a separate study, researchers identified a predictive relationship
 between small pupil size in adolescents with type 1 diabetes and the
 presence of microalbuminuria and retinopathy 12 years later. Small pupil
 size has been used to predict mortality in adults with diabetes but has not
 often been used in adolescents.
     This study, by researchers in Australia, found that adolescents with
 type 1 diabetes whose pupils were reduced in size were at higher risk for
 complications from their disease in their 20s. In particular, they were at
 greater risk for retinopathy - a progressive eye disease - and
 microalbuminuria, or the presence of small amounts of albumin in the urine,
 which indicate cardiovascular and kidney problems.
     The researchers recommend further research to determine if improved
 glycemic control when pupil abnormalities first appear would improve the
 condition and lead to fewer complications.
     Clinical Practice Recommendations Updated
     The ADA's Clinical Practice Recommendations have been updated to
 include new information about treatment and prevention that reflects the
 latest research. Changes have been made in numerous areas, including the
 management of hyperglycemia in type 2 diabetes; nutrition recommendations;
 and screening and treatment for children who have both type 1 diabetes and
 celiac disease.
     Managing hyperglycemia can be a problem for many people with type 2
 diabetes. The revised recommendations now include information from a
 Consensus Statement published by the ADA and the European Association for
 the Study of Diabetes (EASD), which advises early intervention with
 metformin in combination with lifestyle changes to improve glycemic
 control. It also advises early initiation of insulin for those who present
 with weight loss and more severe symptoms.
     In 2006, the ADA published Medical Nutrition Therapy (MNT) guidelines
 for people with diabetes, specific to individual populations, such as those
 who are obese or pregnant. The Clinical Practice Recommendations have been
 updated to reflect these guidelines and to encourage people with diabetes
 or pre- diabetes to seek individualized MNT to help them achieve their
 treatment goals.
     Information about how to treat children who are diagnosed with both
 type 1 diabetes and celiac disease was also added to the Clinical Practice
 Recommendations this year. Up to 16 percent of children with type 1
 diabetes are also diagnosed with celiac disease, an immune disorder that
 affects the digestive system, damages the small intestine and interferes
 with the absorption of nutrients from food. The recommendations call for
 more aggressive screening for celiac disease in children with type 1
 diabetes who present symptoms such as weight loss, growth failure,
 abdominal pain and chronic fatigue. A gluten-free diet is recommended for
 those who test positive for celiac.
     Diabetes Care, published by the American Diabetes Association, is the
 leading peer-reviewed journal of clinical research into the nation's fifth
 leading cause of death by disease. Diabetes also is a leading cause of
 heart disease and stroke, as well as the leading cause of adult blindness,
 kidney failure, and non-traumatic amputations. For more information about
 diabetes, visit the American Diabetes Association Web site or call 1-800-DIABETES (1-800-342-2383).

SOURCE American Diabetes Association