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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The study has also shown that after 10 years one third have a complication that requires clinical attention, including heart attacks, strokes, laser treatment of the eyes, treatment for renal failure or amputations.

These figures are valuable ammunition in the battle to improve services for patients. New Engl J Med. Therefore a study to show whether a treatment will prevent complications has to be a long-term study. The study showed that eatudio blood pressure treatment is acceptable to people with diabetes, and that better blood pressure control than standard management can be obtained.

Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions.

This would allow early therapy to be given before the processes which lead to complications can operate.

Key points Figure 4. Any patients unable to attend clinics were sent EQ-5D and health resource questionnaires, with additional questionnaires to their general practitioners to captured possible endpoints. The study also assessed effects of intensive treatment on quality of life; no adverse effect was apparent. In trials such as this, patients are selected both by investigators and by themselves.

These two approaches have now been shown to be the key to maintaining the health of patients.

As soon as diabetes is diagnosed, to give best chance of preventing complications. Received Mar 15; Accepted Aug In addition, actual therapy often differed from allocated treatment, especially as patients required additional treatment over time. Three aggregate endpoints diabetex used to assess differences between conventional and intensive treatment: One diqbetes demonstrated that poor quality of life is related to complications rather than the treatments given [unpublished].


The second statement is as true today as it was almost years ago.

UK Prospective Diabetes Study

To date, the effectiveness of insulin and oral hypoglycaemic agent combinations is not known, although there are unpublished data from the study on the combination of insulin and sulphonylureas. Moderately high blood glucose levels were accepted into this group. If not fatal they can seriously affect the quality of life.

On the contrary, the pioneering study of the s, the University Group Diabetes Program UGDP [ 8 ], suggested that treatment with tolbutamide might be harmful. Until now there has been little convincing evidence that improved diabetes control will prevent the complications of diabetes.

Open in a separate window. Although apparently a “mild form of diabetes” major complications occur, including death from heart attacks and disability including blindness, amputations and kidney failure.

The study showed that intensive blood glucose eztudio is acceptable and that better blood glucose control could be obtained than with conventional management. The study was set up so that physicians could have a sound basis for deciding which treatments they should prescribe to patients. Table 1 Absolute risk.

Single clinical endpoints and surrogate subclinical endpoints were also assessed. The study was stopped after 8 years because of an increase in cardiovascular deaths in those receiving tolbutamide. Improved blood-glucose control decreases the progression of diabetic microvascular disease, but the effect on macrovascular complications is unknown.

They were seen annually until in UKPDS clinics with continued standardized collection of endpoint, biochemical and clinical data. No threshold was seen, i.

In the last 2 years, the results of several other studies of hypertension which have included patients with diabetes have been published.


Therefore inan additional study was set up in over people with diabetes and a high blood pressure. The study finished at the end of After 10 years of diabetes, the people with diabetes in the study had a 2-fold greater mortality than the dabetes population.

This has diabetea an acceptable clinical practice, in view of the lack of ukpdds evidence to show that intensive treatment of blood glucose or blood pressure will prevent ukpda, and thus help to maintain the health of patients.

A study on the effects of hypoglycaemic agents on vascular complications in patients with adult-onset diabetes. Br J Clin Pharmacol. At present diabetic complications are often regarded as being a natural outcome from a chronic disease.

Intensive glucose control significantly reduced any diabetes-related end point, but had no effect on mortality. There was no difference for any of the three aggregate endpoints between the three intensive agents chlorpropamide, glibenclamide, or insulin.

The incidence of diabetes has doubled every 20 years since [ 2 ]. Blood pressure, antihypertensive drug treatment and the risks of stroke and coronary heart disease.

UK Prospective Diabetes Study : Protocol

There is concern that sulphonylureas may increase cardiovascular mortality in patients with type 2 diabetes and that high insulin concentrations may enhance atheroma formation. Eshudio The social and cost implications of Type II diabetes. Prevention would be the ideal solution, but is currently a remote prospect. Author information Article notes Copyright and License information Disclaimer. Data on possible dose-dependent effects of insulin, and the combination of insulin and metformin are lacking.