Until now, the implications of these delays on patients' health had not been quantified. Laiteerapong and colleagues built computer models using published data to determine the magnitude of harm caused by different delays in controlling blood pressure in patients from 50-59 years of age with newly diagnosed type 2 diabetes. The damage caused by a one-year delay "may be small," they concluded but delays of ten years or more were comparable to smoking in patients with cardiovascular disease.
Given time to learn how, many patients would prefer to control blood pressure through diet and exercise rather than with antihypertensive medications. Most guidelines, however, including those of the ADA, recommend at most a three-month trial of medication-free lifestyle therapy for patients with moderately elevated blood pressure. They call for immediate initiation of medication for those with blood pressure more than 10mmHg above the goal.
That is often not enough time for patients to learn the methods, develop good habits and demonstrate improvements.
"We ask patients with diabetes to do a billion things," Laiteerapong said, "to test their blood sugars, to count carbohydrates, to spend 30 minutes a day doing exercise, including cardio and weight training. Most, if not all, of this is new to them. They need time to adapt. It's important to do this right, but our results say it's not that important to do it so fast."
This study argues that caregivers should work with patients to help them gain the knowledge and develop the necessary skills gradually rather than rushing to drug treatment, especially if their blood pressure is only mildly elevated. It suggests that patients and providers "have more time," the authors write, "at least up to one year, to focus on diabetes self-management and lifestyle modification."
"Among middle-aged adults with diabetes, the harms of a one-year delay in managing blood
|Contact: John Easton|
University of Chicago Medical Center