THE UNITED KINGDOM PROSPECTIVE DIABETES STUDY (UKPDS)The United Kingdom Prospective Diabetes Study (UKPDS), the largest clinical research study of diabetes ever conducted, provided conclusive evidence that the life threatening complications of type 2 diabetes can be significantly reduced by appropriate treatment.
5102 patients with newly diagnosed type 2 diabetes were followed-up for a median time of 11 years to test the effects of glycaemic control on complications in diabetes.
This study showed that lowering raised blood glucose and blood pressure levels reduced the risk of heart disease, stroke and death from diabetes-related diseases as well as diabetic eye disease and early kidney damage.
THE RESULTS1,2 SHOWED THAT BETTER BLOOD GLUCOSE CONTROL REDUCED THE RISK OF: • major diabetic eye disease by 21%
• early kidney damage by 33%
BETTER BLOOD PRESSURE CONTROL, IN THE MANY PATIENTS WHO HAVE HIGH BLOOD PRESSURE, REDUCED THE RISK OF1,3: • death from long-term complications of diabetes by 32%
• strokes by 44%
• serious deterioration of vision by 47%
One of the most striking observations of the UKPDS was the progressive nature of type 2 diabetes and the failure of traditional treatments to maintain glycaemic control over time.4,5 Approximately half of patients on oral monotherapy progressed to polypharmacy within three years, indicating a need for more effective therapies for type 2 diabetes.4
In UKPDS, patients were randomised between a conventional blood glucose control regimen, keeping fasting plasma glucose <15 mmol/l, and an intensive glucose control regimen with sulphonylurea or insulin, aiming for fasting plasma glucose <6 mmol/l. The results showed a marked deterioration of glycaemia with time, due to a progressive decrease in beta-cell function.1
The intensive regimen reduced the risk of any diabetes-related endpoints, (microvascular, macrovascular and cataract extraction) by 12% (p=0.029), microvascular endpoints by 25% (p=0.0099), with a borderline significant 16% risk reduction in myocardial infarction (p=0.052) and a 24% risk reduction in cataract extraction (p=0.046).1
The study further randomised 1,148 people with hypertension in addition to their type 2 diabetes to a less tight blood pressure control regimen or a tight blood pressure control regimen achieving mean blood pressure levels of 154/87 mm Hg and 144/82 mm Hg respectively over median 8.4 years. The tight blood pressure control regimen reduced the risk of any diabetes-related endpoints by 24% (p=0.0046), microvascular endpoints by 37% (p=0.0092) and strokes by 44% (p=0.0013). It also reduced deterioration of visual acuity by 47% (p=0.0036), suggesting less diabetic maculopathy - the major cause of blindness in type 2 diabetes.1
The UKPDS results clearly demonstrated that the complications of type 2 diabetes are not an inevitable outcome of this chronic disease: risk can be reduced by appropriate therapy. Improved therapies may yield even greater improvement in risk if they can offer durable glycaemic control and help preserve beta cell function.
References 1. Overview of the United Kingdom Prospective Diabetes Study - The UKPDS Diabetes Trials Unit, Radcliffe Infirmary, Woodstock Road, Oxford, UK Δεν είναι ορατοί οι σύνδεσμοι (links).
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ΕίσοδοςSee also: Diabetes UK, 1999, UKPDS - Implications for the care of people with type 2 diabetes
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Εγγραφή ή Είσοδος 2. UK Prospective Diabetes Study Group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352:837-853.
3. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ 1998; 317:703-713.
4. Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus. Progressive requirement for multiple therapies (UKPDS 49). JAMA 1999; 281:2005-2012.
5. Brown J, Nichols G, Glauber H, Bakst A. Ten-year follow-up of antidiabetic drug use, nonadherence, and mortality in a defined population with type 2 diabetes mellitus. Clin Therap 1999; 21:1045-1057.
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