Differences in treatment and metabolic abnormalities between normo- and hypertensive patients with type 2 diabetes: the Skaraborg Hypertension and Diabetes Project

Aim: To examine treatment and glucose control in type 2 diabetes patients w ith and without hypertension, and to explore differences in markers for ins ulin resistance and beta cell function. Methods: A community-based, cross-sectional observational study was carried out at the hypertension and diabetes outpatient clinic in primary health c are, Skara, Sweden. The subjects were all the 400 patients with type 2 diab etes (202 men, 198 women) who underwent annual follow-up from May 1992 thro ugh September 1993; 204 of these also had hypertension. Results: The patients with both type 2 diabetes and hypertension had a high er b.m.i. (mean; 28.9 kg m(-2) (s.d.; 4.4) vs. 27.4 kg m(-2)(4.6)), higher triglycerides (2.0 mmol l(-1)(1.1) vs. 1.7 mmol l(-1) (1.1)), higher LDL/HD L cholesterol ratio (4.3(1.4) vs. 4.1(1.2)) and higher fasting insulin (8.5 mU l(-1) (1.1) vs. 6.6 mU l(-1)(1.1)). Conversely, glucose levels were low er; HbA1c (6.4%(1.4) vs. 6.8%(1.6)) and fasting blood glucose (8.1 mmol l(- 1)(2.3) vs. 8.9 mmol l(-1)(2.7)) than in patients with type 2 diabetes alon e. By the homeostasis model assessment (HOMA), patients with type 2 diabete s alone had more impaired beta cell function. They also had a higher freque ncy of insulin treatment (20% vs. 12%) and were less often treated non-phar macologically (33% vs. 50%). Conclusions: Patients with type 2 diabetes and hypertension constitute a hi gh risk category with a more atherogenic risk factor profile related to the insulin resistance syndrome. Patients with type 2 diabetes without hyperte nsion seem to constitute a subgroup of type 2 diabetes with predominately i mpaired beta cell function.