The burden of diabetic renal disease, recognized since the second century a. Association of glycemia with macrovascular and microvascular complications of type 2 diabetes ukpds 35. United kingdom prospective diabetes study ukpds landmark. To determine whether tight control of blood pressure prevents macrovascular and microvascular complications in patients with type 2 diabetes. The studies also aim to evaluate potential risk factors for the development of diabetic complications such as smoking, obesity, central adi posity, plasma ldl and. Validation of the ukpds 82 risk equations within the cardiff. The ukpds was a randomized, prospective, multicenter trial of intensive glucose therapy in subjects with newly diagnosed type 2 diabetes mellitus. The studies also aim to evaluate potential risk factors for the development of diabetic complications such as smoking, obesity, central adiposity, plasma ldl and. Mar 15, 1999 hypertension in diabetes study 18, 19one thousand one hundred and fortyeight patients took part. The uk prospective diabetes study ukpds is a multicentre, prospective, randomised, intervention trial of 5100 newlydiagnosed patients with type 2 noninsulinde pendent diabetes mellitus which aims to determine whether improved blood glucose control will prevent complications and reduce the associated morbidity and mortality. Jan 14, 1995 united kingdom prospective diabetes study ukpds. Background the progression of nephropathy from diagnosis of type 2 diabetes has not been well described from a single population. The ukpds showed that longterm complications of type 2 diabetes can be prevented through intensive blood glucose and blood pressure management.
The primary aim was to compare conventional treatment primarily with diet alone with intensive treatment with metformin,1012 with a secondary aim of comparing the group allocated metformin with overweight patients allocated sulphonylurea or insulin therapies. Microvascular and macrovascular complications of diabetes. The united kingdom prospective diabetes study ukpds was a clinical study conducted by z that was published in the lancet in 1998. Hypertension is a commonly associated condition with type 2 diabetes. Complications study, the cumula tive incidence of microalbuminuria in patients with type 1 diabetes was 12% during a period of 7 years. In addition, some studies have suggested that hyperinsulinaemic states are atherogenic 17, and the. There were 5102 patients recruited to the study, who met inclusion criteria listed previously.
The uk prospective diabetes study ukpds was a landmark randomised, multicentre trial of glycaemic therapies in 5,102 patients with newly diagnosed type 2. These two studies provided compelling evidence that glycemic control can prevent the onset and progression of diabetic microvascular complications like neuropathy, nephropathy and retinopathy. The uk prospective diabetes study ukpds was a landmark randomised, multicentre trial of glycaemic therapies in 5,102 patients with newly diagnosed type 2 diabetes. Mortality in the ukpds 1997 cardiac 41% sudden 6% stroke 9% unknown 2% cancer 25% accident 2% other 15% end of the trial 1997. Reviews long awaited results the main clinical findings of the uk prospective diabetes study ukpds have just been published. The united kingdom prospective diabetes study ukpds was conceived to explore these uncertainties and. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvasvular complications in type 2 diabetes. Half the participants were allocated to tight control target blood pressure less than 15085 mm hg and were randomised to either atenolol or captopril, with other agents added as necessary. Patients who had a fasting plasma glucose fpg greater than 6 mmoll on two mornings, weeks apart, were eligible for the study. Effect of intensive bloodglucose control with metformin on complications in overweight patients with type 2 diabetes ukpds 34. Contribution to clinicians of the last revision of the ukpds study given where.
Patients generally attended a ukpds clinic within 2 weeks of referral. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. Effect of intensive bloodglucose control with metformin on. Followup of intensive glucose control in type 2 diabetes. Participants in the trial who were receiving intensive treatment will now be switched over to standard treatment.
The uk prospective diabetes study ukpds is a multicentre, prospective, randomised, intervention trial of 5100 newlydiagnosed patients with type 2 noninsulinde pendent diabetes mellitus which aims to determine whether improved blood glucose control will prevent complications. Of note, the main analysis performed by the ukpds is identical to the analysis performed in the dcct. The uk prospective diabetes study ukpds, a clinical trial of a policy of intensive control of blood glucose after diagnosis of type 2 diabetes, which achieved a median haemoglobin a 1c hba 1c of 7. This ukpds cardiac risk calculator assesses risk of coronary heart disease with diabetes, hemoglobin a1c and cholesterol levels based on the uk prospective diabetes study. Twentythree years ago, the oxford university group and their collaborators started the united kingdom prospective diabetes study ukpds, and since then they have reported its results in more than 40 publications. This early reduction in the hba 1c level explains the socalled legacy effect found in the ukpds united kingdom prospective diabetes study, stated marcus lind, md, of the. In both studies, intensive treatment designed to achieve. What are the major findings of the united kingdom prospective. The united kingdom prospective diabetes study or ukpds compared conventional and intensive therapy in more than 5,000 newly diagnosed people with type 2 diabetes.
Obesity is common among patients with type 2 diabetes. The ukpds was also designed to determine whether there are differences between conventional policy diet therapy and three different regimens of intensive treatment policy. Other findings of the ukpds have deservedly received attention. We summarize the key study results and their implications for clinical management of type 2 diabetes mellitus. The care of patients with type 2 diabetes mellitus has been profoundly shaped by the results of the united kingdom prospective diabetes study ukpds.
For example, the trial showed that sulfonylureas, metformin, and insulin are equally effective in reducing microvascular complications and that contrary to fears about sulfonylureas and insulin none of these agents caused harm through cardiovascular or other toxicity. Introduction the range of therapies to prevent, delay or treat type 2 diabetesrelated complications is rapidly expanding, and it is. Abstractthe united kingdom prospective diabetes study ukpds showed that intensive treatment ie, glucoselowering drugs, with a goal fasting blood glucose level of 108 mgdl decreases the microvascular complications of type 2 diabetes mellitus. Discover more about the study, instructions on how to calculate the risk and understand the involved factors below the form. Implications of the united kingdom prospective diabetes study. Dec 18, 2014 in one large, ongoing trial of people with type 2 diabetes and a high risk of cardiovascular disease, intensive blood glucose control has been linked with a slightly higher risk of death compared with lessintensive, standard treatment. Performance of the ukpds outcomes model for prediction of.
Contribution to clinicians of the last revision of the ukpds. The ukpds studied metformin primarily in obese patients, since when the study started 1970s, metformin was generally prescribed only in such patients. In one large, ongoing trial of people with type 2 diabetes and a high risk of cardiovascular disease, intensive blood glucose control has been linked with a slightly higher risk of death compared with lessintensive, standard treatment. The recently published swedish trial in old patients with hypertension2 compared the use of blockers or diuretics with the use of ace inhibitors or ca antagonists and was not included because outcome data in. The ukpds ran for 20 years and recruited over 5000 patients, making it the largest and longest running study of its kind. Effect of intensive bloodglucose control with metformin. Contribution to clinicians of the last revision of the.
Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed noninsulin dependent diabetes followed for three years. Moneta, md, section editor aspirinandextendedreleasedipyridamolevs. Background during the united kingdom prospective diabetes study ukpds, patients with type 2 diabetes mellitus who received intensive. The uk prospective diabetes study ukpds showed that hba1c, was an independent predictor of cardiovascular outcomes 9. When ukpds investigators analysed 500 myocardial infarcts that occurred during the study, of which 52% were fatal, multivariate analyses albeit post hoc documented that patients with fatal myocardial infarct had a higher hba1c around the time of diagnosis, many years before the event, compared with those with nonfatal myocardial infarcts 6. The united kingdom prospective diabetes study ukpds reported by holman et al. Newly presenting type 2 diabetic patients aged 2565 years. The oxford centre for diabetes, endocrinology and metabolism title. Tight blood pressure control and risk of macrovascular and. Articles effect of intensive bloodglucose control with. Best publicized has been the randomized comparison between a conventional treatment policy using diet alone and an intensive policy beginning with. Development and progression of nephropathy in type 2 diabetes. Although the study failed to identify a superior treatment to prevent recurrent stroke, we now know the expected risk of recurrent stroke in patients treated according to the study protocol. Around 3,800 people with type 2 diabetes were followed for an average of ten years, and were treated with tight glucose control or the standard of care, and again the treatment arm had far better outcomes.
Does intensive therapy of type 2 diabetes help or harm. The united kingdom prospective diabetes study ukpds showed that intensive treatment ie, glucoselowering drugs, with a goal fasting blood glucose level of 108 mgdl decreases the microvascular complications of type 2 diabetes mellitus. Randomised controlled trial comparing tight control of blood pressure aiming at a blood pressure of. In comparison to the general population, a disproportionately large percentage of patients with esrd have diabetes. Using the current definition of 85 mmhg proposed by the joint national commission vi report from the usa then 85% of 1565 type 2 patients in our diabetic clinic in middlesbrough would be classified as hypertensive. United kingdom prospective diabetes study ukpds diabetes. Development and progression of nephropathy in type 2.
It ran for twenty years 1977 to 1997 in 23 uk clinical sites and showed conclusively that the complications of type 2 diabetes, previously often regarded as inevitable, could be. Study ukpds from 1977 as part of the original protocol in the first 15 centres. The united kingdom prospective diabetes study ukpds 64. This research project followed the results of different therapies for 10 years with the conclusions reported in numerous articles in professional. This early reduction in the hba 1c level explains the socalled legacy effect found in the ukpds united kingdom prospective diabetes study, stated marcus lind, md, of the department of molecular and clinical medicine, institute of medicine, sahlgrenska academy, university of gothenburg, sweden, who presented an analysis in a latebreaking. The uk prospective diabetes study ukpds is a multicentre, prospective, randomised, intervention trial of 5100 newlydiagnosed patients with type 2 noninsulindependent diabetes mellitus which aims to determine whether improved blood glucose control will prevent complications and reduce the associated morbidity and mortality. The united kingdom prospective diabetes study ukpds found patients with newly diagnosed type 2 diabetes who received intensive. Request pdf ukpds and the legacy effect the united kingdom prospective diabetes study ukpds continues to produce important evidence concerning. Clopidogrelforrecurrent stroke sacco rl, diener hc, yusuf s, and the profess study group. United kingdom prospective diabetes study followup.
The uk prospectiv e diabetes study ukpds, a clinical trial of a policy of intensive control of blood glucose after diagnosis of type 2 diabetes, which achieved a. Ukpds and the legacy effect request pdf researchgate. Posttrial monitoring of patients who participated in the original ukpds study indicates that early, aggressive lowering of glucose had protective effects, even 10 years after randomization ended. Methods during 30 700 personyears of followup, 188 first strokes 52 fatal occurred. In a recently reported genomewide association study, the rs11212617 snp was determined to be associated with the efficacy of metformin treatment in type 2 diabetes 1. Followup of intensive glucose control in type 2 diabetes nejm. The specific external validation studies included in this analysis were. The united kingdom prospective diabetes study ukpds, the largest clinical research study of diabetes ever conducted, has provided conclusive evidence that the life threatening complications of type 2 diabetes non insulin dependent diabetes can be significantly reduced by appropriate treatment. Blood pressure control in type 2 diabeteswhat does the. The united kingdom prospective diabetes study ukpds continues to produce important evidence concerning the evolution of type 2 diabetes and its management. Data from the 5102 patients with type 2 diabetes in the uk prospective diabetes study ukpds provide an opportunity to derive a diabetesspecific model for risk of stroke. Posttrial monitoring of patients who participated in the original ukpds study indicates that early, aggressive lowering of glucose had protective effects. We developed mathematical models to estimate the risk of a first stroke using data from 4549 newly diagnosed type 2 diabetic patients enrolled in the uk prospective diabetes study.
1008 1641 1114 753 1309 1487 658 256 615 389 670 1067 577 677 1368 660 670 631 1024 714 866 579 1138 128 1554 1482 1182 1638 80 843 167 1067 1231 1409 344 833 1029 934 238 960 370 1135