Introduction to the Second World Congress on Controversies to Consensus in Diabetes, Obesity and Hypertension (CODHy)

Abstract

Successful management of obesity, diabetes, and hypertension is a matter of great urgency in current medical practice because of the soaring prevalence of these three interrelated conditions worldwide. Their complications (first and foremost, cardiovascular disease) result in significant morbidity, which exerts a heavy toll on health care systems everywhere, especially in industrialized countries. Because the causes and effects of obesity, diabetes, and hypertension are closely intertwined, preventing their complications requires a comprehensive approach. Massive research into the etiology and treatment of these three afflictions has recently generated vast amounts of data, which call into question many of the accepted treatment paradigms. They present physicians in clinical practice with the daily challenges of integrating innovative therapies into the treatment protocol, addressing difficult questions and making controversial decisions. One of the major dilemmas faced by physicians in this field stems from the recent trials that revealed the relatively small benefits of blood glucose control in certain diabetic patients compared with the possible morbidity and mortality risk. On the one hand, follow-ups to the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT-EDIC) (1) and the U.K. Prospective Diabetes Study (UKPDS) (2) have supported the importance of early diabetes control in preventing later cardiovascular events and microvascular complications. Moreover, the STENO-2 Follow-Up Study (3) from the Steno Diabetes Center in Copenhagen demonstrated that early treatment of cardiovascular risk factors reduces cardiovascular morbidity and mortality years later. On the other hand, however, the results of several trials—the Action in Diabetes and Vascular Disease Trial (ADVANCE) (4), the Action to Control Cardiovascular Risk in Diabetes Study (ACCORD) (5), the VA Diabetes Trial (VADT) (6), and Heart 2D study (7)—have cast doubt on the benefits of tight glucose control in older patients with longstanding disease (the only exception being the …