Effectiveness of Individual-Level Interventions to Prevent Vascular Complications

© 2011 by Oxford University Press. All rights reserved. This chapter covers interventional studies aimed at lowering the incidence of cardiovascular disease (CVD), nephropathy, retinopathy, blindness, lower-extremity amputation (LEA), peripheral sensory neuropathy, and autonomic neuropathy; and at prolonging life. It includes studies that address clinical endpoints. It shows that individuals with diabetes and their providers of care can reduce the occurrence of diabetic complications by lowering glucose, blood pressure, and LDL, either alone or in combination. Nonpharmacologic interventions, chiefly those related to retinopathy and obesity, also improve outcomes. To date evidence for lowering blood glucose and blood pressure does not support the use of specific agents except possibly metformin and blockade of the angiotensin system. For LDL, statins remain the intervention of choice.