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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Although apparently a “mild form of diabetes” major complications occur, including death from heart attacks and disability including blindness, amputations and kidney failure.
UK Prospective Diabetes Study : Protocol
Whether the same holds true in type 2 diabetes remained uncertain. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes UKPDS 34 Lancet.
In Type 1 diabetes a large American study DCCT showed that there is a close relationship between the control of diabetes and the risk of developing certain specific complications, such as eye, kidney or nerve disease. The study was set up so that physicians could have a sound basis for deciding which treatments they should prescribe to patients.
From the point ykpds view of their age and racial mix, these people were representative of the typical British patient with Type 2 diabetes. After 10 years of diabetes, the people with diabetes in the study had a 2-fold greater mortality than the general population. Until now there has been little convincing evidence that improved diabetes control will prevent the complications of diabetes.
The “complications” can arise from damage to large arteries that cause heart attacks and strokes. There is concern that sulphonylureas may increase cardiovascular mortality in patients with type 2 diabetes and that high insulin concentrations may enhance atheroma formation.
Thus, unlike blood pressure control, intensive glycaemic control is not suitable for all patients, particularly the elderly, or those with existing severe complications. Despite these limitations, the UKPDS provides evidence and quantitative guidelines for those in whom intensive control is achievable.
The benefits of treatment? When single treatments failed, combinations were used. In modern society, the first statement is far from true. Furthermore, the mortality in the group treated by sulphonylureas alone was unexpectedly low.
Efficacy of atenolol and captopril in reducing risk of macrovascular and microvasvular complications in type 2 diabetes: That the reduced occurrence of myocardial infarction was not significant may be due to type 2 statistical error. There was no difference for any of the three aggregate endpoints between the three intensive agents chlorpropamide, glibenclamide, or insulin.
It is therefore frequently called “mild diabetes”. 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 estudoi amputations.
Questionnaires were given to people in the study to assess their quality of life with questions assessing mood, work satisfaction, symptoms and everyday mistakes.
Received Mar 15; Accepted Aug However, for many years the design and conduct of the UGDP were subject to fierce debate which was never satisfactorily resolved; uncertainty continued about treatment and glycaemic targets for type 2 diabetes.
It was the largest and longest study ever undertaken in diabetes; median follow-up was 10 years. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
When diet failed to achieve these targets, subjects were randomized to sulphonylureas, insulin or metformin, the latter in obese patients only. Cloning and functional expression of a rat heart K-ATP diwbetes.
UK Prospective Diabetes Study
The incidence of diabetes has doubled every 20 years since [ 2 ]. This article has been cited by other articles in PMC. Thus doctors treating the most common form of diabetes did not know how hard they and people with Type 2 diabetes should strive to keep blood glucose near-to-normal. The UKPDS provides management guidelines for selected patients, but leaves many questions unanswered.
UKPDS esturio patients who were allocated to various treatment groups. 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.
The problem has simply been that the complications of diabetes come on over decades. People with diabetes may often require three different types of tablet and even then insulin treatment is required by many patients.
Specific viabetes complications can also develop, due to closure of small blood vessels that can cause blindness, kidney failure and amputations.
In addition, some studies have suggested that hyperinsulinaemic states are atherogenic [ 17 ], and the increased incidence of hypoglycaemia with intensive control with insulin could theoretically precipitate a cerebrovascular or cardiovascular event. Blood pressure, antihypertensive drug treatment and the risks of stroke and coronary heart disease.
The Study has shown that insulin is an acceptable treatment when given at an earlier stage of Type 2 diabetes than currently is the practice. The effect of angiotensin-converting enzyme inhibition on diabetic nephropathy. In the study, patients were reviewed 3 monthly, rather than 6—12 monthly as in routine clinical practice, which has considerable resource implications. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: In a large American study DCCT was published which showed a close relationship between control of Type 1 diabetes and the risk of complications from small vessel disease.
The UKPDS showed no difference in outcome between treatments, which is at first sight reassuring, but the study was powered to assess diabeted effects of intensive dibaetes in general and it is unclear whether there is adequate power in this subgroup analysis.
The observation that UKPDS patients had a lower mortality than the general population with type 2 diabetes may be a reflection of this.