New study reveals people with early onset type 2 diabetes can significantly reduce their blood pressure and urinary albumin excretion by modest reduction in salt intake

9th May 2016

New research published today in Hypertension (9th May 2016); ‘Modest salt reduction lowers blood pressure and albumin excretion in impaired glucose tolerance and type 2 diabetes mellitus’1 , has shown that in people with early onset type 2 diabetes, a modest reduction in salt intake led to a significant fall in blood pressure and urinary albumin excretion2 – reducing their risk of suffering from strokes, heart attacks and kidney disease. This is the first time that this has been so conclusively demonstrated.

CASH is now calling for ALL patients with type 2 diabetes and glucose intolerance to be shown how to reduce their salt intake to prevent further deaths.

The study was a carefully conducted 12 week randomized double-blind, crossover study of 46 individuals with type 2 diabetes or impaired glucose tolerance and normal or mildly raised blood pressure (~134/82 mmHg). Patients were asked to reduce their salt intake to ~5g/day and continued on this reduced salt intake for the duration of the study. After 2 weeks, they were randomised either to take salt tablets (5g salt/day), or the equivalent number of placebo tablets (0g salt) for 6 weeks. At the end of the 6-week period the participants crossed over to take the opposite tablets for a further 6 weeks. Blood pressure was measured before entry to the study and at the end of each 6-week period. At the end of the 6-week crossover, salt intake fell by 2.9g/day (from 9.7g to 6.9g) and with this reduction in salt intake, blood pressure fell significantly from 135.5±2.0 / 81.3±1.1 mmHg with salt to 131.2±1.9 / 79.7±1.2 mmHg with placebo (P<0.01).

Dr Rebecca Suckling, Consultant Nephrologist at St Helier Hospital and lead author of the research says “This study is the first and largest study of dietary salt intake in patients with type 2 diabetes or impaired glucose tolerance early on in their disease and has shown that lowering salt intake reduces blood pressure and the urinary albumin level, both important risk factors for cardiovascular disease and kidney failure. Reducing blood pressure through lifestyle changes is recommended by all national and international guidelines but patients do not consistently receive any advice on lowering salt intake.  This study highlights that all patients with type 2 diabetes and impaired glucose tolerance should be given advice on lowering salt intake to levels at least less than 6g a day. ”

Currently, the number of people diagnosed with diabetes in the UK is estimated to be 3.5 million, 90% of which have type 2 diabetes3.  This number is set to rise worldwide as the prevalence of overweight and obesity increases, and will continue to do so until preventive measures are carried out4. Worldwide, it is predicted that there will be a global rise in the number of people with diabetes mellitus from 171 million people in 2010 to 366 million by 20305.

Raised blood pressure is one of the most important risk factors in type 2 diabetes, with at least a twofold increased risk in developing cardiovascular disease compared to those who do not have type 2 diabetes or glucose intolerance6. This study clearly demonstrates that a modest reduction in salt intake causes a significant reduction in both blood pressure and albumin excretion, which will reduce their risk of developing strokes, heart attacks and heart failure as well as being likely to reduce the risk of kidney disease.

Professor Graham MacGregor, Professor of Cardiovascular Medicine at Queen Mary University of London and Chairman of CASH says “This study clearly demonstrates that salt reduction is effective in lowering blood pressure in patients with type 2 diabetes or glucose intolerance. This is the first time that this has been so conclusively demonstrated and it is important now that all patients with type 2 diabetes or glucose intolerance are given appropriate advice on how to reduce their salt intake.

This study also has public health implications in that it is vital that we continue to reduce salt intake in the UK by getting the food industry to take out the huge and completely unnecessary amounts of salt that they put into our food (80% of our current intake). Currently, the world leading UK salt reduction strategy has been stopped whilst David Cameron dithers on his Childhood Obesity Strategy to tackle obesity and type 2 diabetes. This plan will apparently also contain a new strategy to reduce salt intake but we have been waiting for Cameron to decide for almost over a year7".

                                                                                -     ENDS     -

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1 – Suckling RJ, He FJ, Markandu ND, MacGregor GA. Modest salt reduction lowers blood pressure and albumin excretion in impaired glucose tolerance and type 2 diabetes mellitus. A randomised double-blind trial. Hypertension. 2016;67:00-00. DOI: 10.1161/ HYPERTENSIONAHA.115.06637

2 – Urinary albumin excretion is a marker of cardiovascular disease and predicts renal and cardiovascular complications in diabetes mellitus.  

3 – Diabetes UK November 2015 Facts and Stats. https://www.diabetes.org.uk/Documents/Position%20statements/Diabetes%20UK%20Facts%20and%20Stats_Dec%202015.pdf

4 – Public Health England report on Adult Obesity and Type 2 Diabetes. Published July 2014. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/338934/Adult_obesity_and_type_2_diabetes_.pdf

5 - Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–1053.

6 - Emerging Risk Factors Collaboration (2010). Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 375 (9733); 2215–2222.

7 - When the coalition government came in in 2010, responsibility for the successful salt reduction strategy was taken away from the Food Standards Agency and a so called Responsibility Deal was set up in 2011, where the food industry was responsible for policing itself. This plan, unsurprisingly, did not work and the Responsibility has now been closed. According to Department of Health officials, a new plan for salt reduction will be part of the  David Cameron’s Childhood Obesity strategy.