Abstract
In order to compare influence of various diabetic treatments on the development of vascular complications, fasting blood sugar, serum lipids, body weight and the occurrence of vascular complications were studied in 429 diabetic patients during the periods of treatment which extended one year to ten years. Causes of death were also analysed in 99 deceased cases among 821 diabetic patients including those who had been treated for less than one year. Among 429 diabetic patients, 87 patients had been treated with diet alone, 206 patients with sulfonylurea, 17 patients with biguanide, 103 patients with insulin and 16 patients with the combination of the oral drugs and insulin. The average fasting blood sugar of these treatment groups showed a significant decrease in 2 years after the initiation of treatment, followed by a gradual increase both in insulin group and in sulfonylurea group. The rate of incidence of cases poorly controlled was highest in those receiving insulin treatment, followed by those treated with sulfonylurea. The incidence of hypercholesterolemia and albuminuria both in sulfonylurea group and in insulin group decreased significantly during the first 2 years after the treatment and increased thereafter. Albuminuria was more frequent in insulin group (20-40%) than in sulfonylurea group (10-20%). No significant difference was found among the groups in the rate of appearance of diabetic retinopathy (10-20%) as well as in the incidence of hypertension (10-30%). The increase in body weight (over 5kg/year) was observed more often in insulin group (15-30%) than in diet group (8-10%). The rate of appearance of ECG abnormality was 10-30% in all groups. Ketonuria and hypoglycemic episode were frequnet (17-30%) in insulin group.
Cancer was the most frequent cause of death in all groups. Diabetic nephropathy was the most common among the vascular complications which led the patients to death. Comparatively speaking, more patients in insulin group (5.8%) died from diabetic nephropathy than those in sulfonylurea group (0.4%) and in diet group (1.3%), while more patients in insulin group (2.1%) and in diet group (1.9%) died from cerebrovascular accidents than those in sulfonylurea group (0.7%). The rate of death from coronary heart disease was 0.7% in diet group, 0.4% in sulfonylurea group and 1.6% in insulin group and these figures were much lower than those reported by the University Group Diabetes Program (UGDP) in U. S. A. The present results, consisted with those from other investigators in Japan, suggest that the death from myocardial infarction in Japan is rare in diabetics receiving sulfonylurea treatment as well as those receiving other treatments. Though the method employed in this study is retrospective one and is different from that of UGDP in several points, it seems that our results did not support the current emphasis on the relationship between sulfonylurea treatment and death form myocardial infarction, as postulated by UGDP.
