This is one of two longitudinal population studies in the New England Journal of Medicine examining diabetes and risk factors. The other study evaluates whether the cardiovascular benefits of stopping smoking are jeopardized by resultant weight gain and consequent increased risk of type 2 diabetes.
According to an editorial, given the high prevalence of obesity and the related increase in type 2 diabetes, prevention of cardiovascular complications is essential. It notes that these two studies provide support for control of cardiovascular risk factors in patients with diabetes, as well as reassurance that the benefits of smoking cessation outweigh the risks of obesity-associated diabetes. It acknowledges that pathways to target levels of risk-factor variables are not always straightforward and often involve issues of lifestyle, adherence to medication, and other behaviours that are hard to modify, despite best attempts. For vulnerable populations, risk-factor control may be especially challenging, as shown by the widening health gap between social classes.