United Kingdom Prospective Diabetes Study (UKPDS)

Introduction

Subjects:

• 3277 individuals with newly diagnosed with type 2 diabetes
• participants were assessed annually, in UKPDS clinics for the 1st 5 years & remotely by questionnaire thereafter

Groups:

• intensive therapy group achieved mean HbA1c level of 7.0%
• standard therapy group achieved mean HbA1c level of 7.9%
• subgroups: sulfonylurea-insulin vs metformin vs standard therapy

Results:

• mean body weight, blood pressure, & creatinine levels were similar in the two group
• by year 5 postintervention, between-group differences in medication use were absent
• the between-group difference in HbA1c disappeared after the first postintervention year
• at 10 years postintervention, mortality was 44%
  • the leading causes of death were
    • cardiovascular disease (52%)
    • cancer (24%)
  • sulfonylurea-insulin subgroup had significant reductions in diabetes-related death (by 17%), all-cause death (by 13%), MI (by 15%), & microvascular disease (by 24%), compared with the standard-therapy group
  • the metformin subgroup also had significant reductions in these outcomes (by 30%, 27%, 33%, & 16%, respectively)

Conclusions:

• a period of improved glycemic control early in the course of type 2 diabetes has an extended benefit
• benefit may vary by pharmacologic strategy

More general terms

• clinical trial