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.
|Country:||Papua New Guinea|
|Published (Last):||6 May 2016|
|PDF File Size:||4.69 Mb|
|ePub File Size:||18.50 Mb|
|Price:||Free* [*Free Regsitration Required]|
Table 1 Absolute risk. They were seen annually until in UKPDS clinics with continued standardized collection of endpoint, biochemical and clinical data. Questionnaires were given to people in the study to assess their quality of life with questions assessing mood, work satisfaction, symptoms and everyday mistakes. Antihypertensive therapy in type 2 diabetes: Effect of intensive blood-glucose control ukdps metformin on complications in overweight patients with type 2 diabetes UKPDS 34 Lancet.
Diabetes is the name given to a disease in which high blood glucose concentrations occur. Epidemiology, complications and costs of diabetes mellitus. Early in the course of the Study, it was apparent that many patients had high blood pressure and they were particularly prone to heart attacks and other complications of diabetes. Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardio-vascular and diabetic complications.
Patients also develop cataracts requiring surgery. The insulin treatment of diabetes: The numbers involved in this subgroup analysis were very small, with few deaths 26 vs 14 in the group treated with diaetes alone and no difference in the incidence of heart attacks or strokes between the groups, only in the proportion who died.
The results of UKPDS suggest that a formal screening programme should be set up to identify diabetes before symptoms occur.
Therapeutic implications, study limitations and outstanding questions Figures 5 — 7. The advantages of good care have been more clearly defined than ever before, but the huge gulf between the benefits achieved in the study and the many frustrations of everyday practice remains. On the other hand, the questionnaire showed that when people had diabetic complications, these adversely affected quality of life. With the increasing prevalence of the condition, these figures will escalate.
Their use also reduced the number of treatment comparisons, thus minimizing the chances of false-positive results, but had the disadvantage of concealing the magnitude of effects on individual end points. Three aggregate endpoints were used to assess differences between conventional and intensive treatment: Improving blood pressure is sometimes easier than improving blood glucose levels, and needs to have a high priority. When diet failed to achieve these targets, subjects were randomized to sulphonylureas, insulin or metformin, the latter in obese patients only.
These occur two or three times more often in people with Type 2 diabetes than in the general population and can cause death at an earlier age than is usual. Weight gain was significantly higher in the intensive group mean 2.
This has been an acceptable clinical practice, in view of the lack of reliable evidence to show that intensive treatment of blood glucose or blood pressure will prevent complications, and thus help to maintain the health of patients. Mortality and survival in type II non-insulin dependent diabetes mellitus. There are two common types of diabetes.
An unexpected finding was that the addition ukpss metformin to sulphonylureas in both obese and nonobese patients was associated with increased mortality. Protocol amendments were made to add topics not originally included. These are very impressive results, establishing that blood pressure control is at least as important as glycaemic control, if not more so, in the prevention of complications in type 2 diabetes.
Support Center Support Center. This dianetes 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. In Type 2 diabetes diabetes, the major problem is complications from large artery disease and it has not been known whether ukpd intensive etsudio would be helpful, particularly as there was concern about whether in the long term some therapies could themselves cause large vessel disease.
Key points Figure 4. In addition, some studies have suggested that hyperinsulinaemic states are atherogenic [ 17 ], estudiio the increased incidence of hypoglycaemia with intensive control with insulin could theoretically precipitate a cerebrovascular or cardiovascular event. For now, until further information is available, clinical practice should be based on achieving glucose and blood pressure reduction by whatever means best suits an individual patient.
Intensive glycaemic control, particularly with insulin, also leads to morbidity from hypoglycaemia and weight gain. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin dependent diabetes mellitus: Diabetes was first recognized years ago by the Ancient Egyptians.
UK Prospective Diabetes Study : Protocol
Both are important, however, obtaining near-normal blood pressure is, in many patients, easier than maintaining near-normal diaabetes glucose levels because more different types of therapies are available. The findings could also be interpreted as indicating that insulin and sulphonylureas are equally harmful in the obese, possibly as a consequence of hyperinsulinaemia.
Over 10 years, haemoglobin A1c HbA1c was 7. The primary aim was to determine the effect of intensive glycaemic control on the incidence of complications; the secondary aim was to assess whether there were differences between treatments Figure 1. Note added in proof We wish to pay tribute to Robert Turner whose recent untimely death is such a tragedy. The study shows that this is not the case and that with good management, including improved blood pressure and blood glucose control, may help to make complications less common and no longer a half-expected outcome.
UK Prospective Diabetes Study
When single treatments failed, combinations were used. Hypertension in Diabetes Study [ 1819 ] One thousand one hundred and forty-eight patients took part. 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. These showed that intensive management was neutral in its effect, with neither an adverse or beneficial effect. Numerous substudies were embedded Figure 2the most notable being the Hypertension in Diabetes Study.