10-year follow-up of intensive glucose control in type 2 diabetes
- PMID: 18784090
- DOI: 10.1056/NEJMoa0806470
10-year follow-up of intensive glucose control in type 2 diabetes
Abstract
Background: During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes mellitus who received intensive glucose therapy had a lower risk of microvascular complications than did those receiving conventional dietary therapy. We conducted post-trial monitoring to determine whether this improved glucose control persisted and whether such therapy had a long-term effect on macrovascular outcomes.
Methods: Of 5102 patients with newly diagnosed type 2 diabetes, 4209 were randomly assigned to receive either conventional therapy (dietary restriction) or intensive therapy (either sulfonylurea or insulin or, in overweight patients, metformin) for glucose control. In post-trial monitoring, 3277 patients were asked to attend annual UKPDS clinics for 5 years, but no attempts were made to maintain their previously assigned therapies. Annual questionnaires were used to follow patients who were unable to attend the clinics, and all patients in years 6 to 10 were assessed through questionnaires. We examined seven prespecified aggregate clinical outcomes from the UKPDS on an intention-to-treat basis, according to previous randomization categories.
Results: Between-group differences in glycated hemoglobin levels were lost after the first year. In the sulfonylurea-insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P=0.04) and microvascular disease (24%, P=0.001), and risk reductions for myocardial infarction (15%, P=0.01) and death from any cause (13%, P=0.007) emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002).
Conclusions: Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients. (UKPDS 80; Current Controlled Trials number, ISRCTN75451837.)
2008 Massachusetts Medical Society
Comment in
-
UKPDS and the legacy effect.N Engl J Med. 2008 Oct 9;359(15):1618-20. doi: 10.1056/NEJMe0807625. N Engl J Med. 2008. PMID: 18843126 No abstract available.
-
Benefits of early intensive glucose control to prevent diabetes complications were sustained for up to 10 years.ACP J Club. 2008 Dec 16;149(6):4. ACP J Club. 2008. PMID: 19071870 No abstract available.
-
Benefits of early intensive glucose control in preventing diabetes-related complications were sustained for up to 10 years.Evid Based Nurs. 2009 Jan;12(1):14. doi: 10.1136/ebn.12.1.14. Evid Based Nurs. 2009. PMID: 19103832 No abstract available.
-
Benefits of early intensive glucose control to prevent diabetes complications were sustained for up to 10 years.Evid Based Med. 2009 Feb;14(1):9-10. doi: 10.1136/ebm.14.1.9. Evid Based Med. 2009. PMID: 19181941 No abstract available.
-
Does intensive glycemic control for type 2 diabetes mellitus have long-term benefits for cardiovascular disease risk?Nat Clin Pract Endocrinol Metab. 2009 Mar;5(3):138-9. doi: 10.1038/ncpendmet1076. Epub 2009 Feb 3. Nat Clin Pract Endocrinol Metab. 2009. PMID: 19190588
-
Preventing cardiovascular disease in type 2 diabetes: where do things stand with glycemic control? Part two.Curr Diab Rep. 2009 Feb;9(1):9-10. doi: 10.1007/s11892-009-0003-z. Curr Diab Rep. 2009. PMID: 19192418 No abstract available.
-
The "legacy effect" associated with intensive glucose control in patients with type 2 diabetes.Curr Diab Rep. 2009 Feb;9(1):63-4. doi: 10.1007/s11892-009-0011-z. Curr Diab Rep. 2009. PMID: 19192426 No abstract available.
-
Diabetes control and cardiovascular risk, Part II: Intensive glucose control--UKPDS follow-up.Prev Cardiol. 2009 Winter;12(1):51-8. doi: 10.1111/j.1751-7141.2008.00020.x. Prev Cardiol. 2009. PMID: 19301692 No abstract available.
-
[Sodium-glucose co-transporter 2 inhibitor for diabetes?].Ned Tijdschr Geneeskd. 2015;159:A9861. Ned Tijdschr Geneeskd. 2015. PMID: 26732223 Dutch.
Similar articles
-
Long-term follow-up after tight control of blood pressure in type 2 diabetes.N Engl J Med. 2008 Oct 9;359(15):1565-76. doi: 10.1056/NEJMoa0806359. Epub 2008 Sep 10. N Engl J Med. 2008. PMID: 18784091 Clinical Trial.
-
Oral antidiabetic agents: current role in type 2 diabetes mellitus.Drugs. 2005;65(3):385-411. doi: 10.2165/00003495-200565030-00005. Drugs. 2005. PMID: 15669880 Review.
-
[Should the occurrence of a first coronary event change the management of diabetes?].Arch Mal Coeur Vaiss. 2000 Dec;93 Spec No 4:39-44. Arch Mal Coeur Vaiss. 2000. PMID: 11296461 Review. French.
-
Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group.Lancet. 1998 Sep 12;352(9131):854-65. Lancet. 1998. PMID: 9742977 Clinical Trial.
-
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group.Lancet. 1998 Sep 12;352(9131):837-53. Lancet. 1998. PMID: 9742976 Clinical Trial.
Cited by
-
Within and post-trial effects of an intensive lifestyle intervention on kidney disease in adults with overweight or obesity and type 2 diabetes mellitus: a secondary analysis of the Look AHEAD clinical trial.BMJ Open Diabetes Res Care. 2024 May 30;12(3):e004079. doi: 10.1136/bmjdrc-2024-004079. BMJ Open Diabetes Res Care. 2024. PMID: 38816203 Free PMC article. Clinical Trial.
-
Influence of early use of sodium-glucose transport protein 2 inhibitors, glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors on the legacy effect of hyperglycemia.Front Endocrinol (Lausanne). 2024 May 13;15:1369908. doi: 10.3389/fendo.2024.1369908. eCollection 2024. Front Endocrinol (Lausanne). 2024. PMID: 38803473 Free PMC article.
-
An update on chronic complications of diabetes mellitus: from molecular mechanisms to therapeutic strategies with a focus on metabolic memory.Mol Med. 2024 May 26;30(1):71. doi: 10.1186/s10020-024-00824-9. Mol Med. 2024. PMID: 38797859 Free PMC article. Review.
-
Diabetes and Stroke: Impact of Novel Therapies for the Treatment of Type 2 Diabetes Mellitus.Biomedicines. 2024 May 16;12(5):1102. doi: 10.3390/biomedicines12051102. Biomedicines. 2024. PMID: 38791064 Free PMC article. Review.
-
Unraveling genetic causality between metformin and myocardial infarction on the basis of Mendelian randomization.Front Endocrinol (Lausanne). 2024 May 3;15:1376464. doi: 10.3389/fendo.2024.1376464. eCollection 2024. Front Endocrinol (Lausanne). 2024. PMID: 38765955 Free PMC article.
Publication types
MeSH terms
Substances
Associated data
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical