Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). We investigated whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.
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Table 1 Absolute risk. The insulin treatment of diabetes: Some people were allocated to a conventional policy, primarily with diet alone. Over subjects at 23 centres across the UK were considered for inclusion; took part. A variety of agents was used, but blood pressure differences between treatment and control groups were comparable with the UKPDS, and protective effects were observed despite shorter periods of follow up 2—5 years. Health Survey for England Received Mar 15; Accepted Aug If not fatal they can seriously affect the quality of life.
Thus there is no doubt of the significance of blood pressure control in type 2 diabetes, but there remains the question whether particular drugs have advantages or disadvantages.
Patients also develop cataracts requiring surgery. UKPDS was a unique, long-term study. People with raised blood pressure as well as diabetes were randomly allocated to a policy aiming for tight blood pressure control, using two treatments that might be thought to be particularly beneficial, an ACE inhibitor or beta-blocker or to a less tight blood pressure control.
In the last 2 years, the results of several other studies of hypertension which have included patients with diabetes have been published. Antihypertensive therapy reduces the risk of both cardiovascular and cerebrovascular disease in the general population [ 12 ], but to estkdio extent these findings apply to type 2 diabetes was again not clear.
UK Prospective Diabetes Study
In addition, the few clinical trials that have been done have raised the possibility that some of the commonly used treatments may aggravate damage to large arteries. Sixteen year follow-up study. In the meantime any way of significantly reducing the burden of diabetes-related complications will have a major impact on patient well-being and on cost effectiveness of management.
The results of metformin treatment are the most controversial [ 14 ]. In uipds centres, there are large numbers of patients with poor control of both blood glucose and blood pressure. This is reassuring in implementing the results of the study, though the results may not apply equally to an unselected population.
Furthermore, the mortality in the group treated by sulphonylureas alone was unexpectedly low.
This article has been cited by other articles in PMC. UKPDS has shown that, by the time diabetes is diagnosed, approximately half of people with Type 2 diabetes already have evidence of diabetic tissue damage.
Despite achieving statistical significance, the absolute risk reduction from intensive glycaemic control is small, with a reduction of 5 events over 10 years compared with 16 for blood pressure Table 1. The study was designed to assess the impact of blood glucose lowering therapies on complications, with patients being randomly allocated to placebo, tolbutamide, phenformin, or insulin. They were seen annually until in UKPDS clinics with continued standardized collection of endpoint, biochemical and clinical data.
Note added in proof We wish to pay diabbetes to Robert Turner whose recent untimely death is such a tragedy.
UK Prospective Diabetes Study : Protocol
One aspect of management inadequately addressed by the study is the optimal combination of drugs to be used either for glucose or blood pressure control. Both ACE inhibitors and beta-blockers have now been shown to be advantageous. As in the glucose control study, rstudio threshold for risk was seen in the hypertension study.
This has been an acceptable clinical practice, in view of the lack of reliable evidence to show that intensive estduio of blood glucose or blood pressure will prevent complications, and thus diahetes to maintain the health of patients. As soon as diabetes is diagnosed, to give best chance of preventing complications.
ACE inhibitors improve survival in patients with heart failure [ 2324 ]; in type 1 diabetes, they reduce the progression of nephropathy [ 2526 ] and possibly retinopathy [ 27 ], but whether ACE inhibitors have specific advantages over other estueio agents in type 2 diabetes is not yet agreed.
The benefits of treatment? Therefore inan additional study was set up in over people with diabetes and a high blood pressure. The UKPDS provides management guidelines for selected patients, but leaves many questions unanswered. Erratum in Lancet Aug 14; There is no doubt that aggressive management of blood pressure is important, particularly in reducing macrovascular disease, the main cause of morbidity and mortality in these patients. Twenty-one diaebtes end points were also defined.
In The social and cost implications of Type II diabetes.
Therapeutic implications, study limitations and diabetee questions Figures 5 — 7. Br J Clin Pharmacol. Moderately high blood glucose levels were accepted into this group. It was the largest and longest study ever undertaken in diabetes; median follow-up was 10 years.