 |
 |
|
|
|  PubMed
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 January 1996 | Volume 124 Issue 1 Part 2 | Pages 136-145
Purpose: To report the progress (after 9-year follow-up) of a study designed to determine whether improved glucose control in patients with newly diagnosed non–insulin-dependent diabetes mellitus (NIDDM) is effective in reducing the incidence of clinical complications.
Data Source: A multicenter, randomized, controlled trial of different therapies for NIDDM. After initial diet therapy, 4209 asymptomatic patients who remained hyperglycemic (fasting plasma glucose levels, 6.0 to 15.0 mmol/L) were assigned to either a conventional therapy policy, primarily with diet alone, or to an intensive therapy policy, aiming for fasting plasma glucose levels of less than 6.0 mmol/L, with assignment to primary therapy with sulfonylurea or insulin (which increased insulin supply) or metformin (which enhanced insulin sensitivity).
Results: All three modes of pharmacologic therapy in the intensively treated group—sulfonylurea, insulin, and metformin—had similar efficacy in reducing the fasting plasma glucose and glycated hemoglobin levels. Over 9 years, patients assigned to intensive therapy with sulfonylurea or insulin had lower fasting plasma glucose levels (median, 7.3 and 9.0 mmol/L, respectively) and lower hemoglobin A1c levels (6.7% and 7.5%, respectively) than patients assigned to conventional therapy. Regardless of the assigned therapy, however, the fasting plasma glucose and hemoglobin A1c levels increased, and maintaining near-normal glycemia was, in general, not feasible. Even insulin therapy did not achieve the therapeutic goal of near-normal glycemia because of the difficulty in treating marked hyperglycemia and the risk for hypoglycemic episodes. Nine years after the diagnosis of diabetes, 29% of the patients had had a diabetes-related clinical end point, 20% had had a macrovascular complication, and 9% had had a microvascular complication.
Conclusions: A report will be published in 1998 after a median duration from randomization of 11 years (range, 6 to 20 years) with an 81% power at a 1% level of significance of detecting whether the obtained improvement in glucose control causes a 15% decrease or increase in the incidence of major complications and whether any specific therapy is advantageous or disadvantageous.
Author and Article Information
From the Radcliffe Infirmary, Oxford; Royal Infirmary, Aberdeen; General Hospital, Birmingham; St. George's Hospital and Hammersmith Hospital, London; City Hospital, Belfast; North Staffordshire Royal Infirmary, Stoke-on-Trent; Royal Victoria Hospital, Belfast; St. Helier Hospital, Carshalton; Whittington Hospital, London; Norfolk and Norwich Hospital, Norwich; Lister Hospital, Stevenage; Ipswich Hospital, Ipswich; Ninewells Hospital, Dundee; Northampton Hospital, Northampton; Torbay Hospital, Torquay; Peterborough General Hospital, Peterborough; Scarborough Hospital, Scarborough; Derbyshire Royal Infirmary, Derby; Manchester Royal Infirmary, Manchester; Hope Hospital, Salford; Leicester General Hospital, Leicester; and Royal Devon and Exeter Hospital, Exeter, United Kingdom.
ONGOING AND PROPOSED TRIALS
United Kingdom Prospective Diabetes Study 17: A 9-Year Update of a Randomized, Controlled Trial on the Effect of Improved Metabolic Control on Complications in Non-Insulin-dependent Diabetes Mellitus
Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled "Risks and Benefits of Intensive Management in Non-Insulin-dependent Diabetes Mellitus: The Fifth Regenstrief Conference." To view a complete list of the articles included in this supplement, please view its Table of Contents.
Acknowledgments: The authors thank the patients and many National Health Service (NHS) and non-NHS staff at the centers for their cooperation. They also thank Mrs. Irene Stratton, Professor Eva Kohner, and Drs. Sue Manley, David Matthews, Andrew Neil, and Jonathan Levy for their collaboration and advice and Ms. Ivy Samuel and Mrs. Caroline Wood for assistance with the manuscript.
Grant Support: From the United Kingdom Medical Research Council; British Diabetic Association; United Kingdom Department of Health; National Eye Institute and National Institute of Digestive and Diabetes and Kidney Disease, National Institutes of Health; British Heart Foundation; Health Promotion Research Trust; Charles Wolfson Charitable Trust; Alan and Babette Sainsbury Trust; Oxford University Medical Research Fund Committee; various pharmaceutical companies, including Novo-Nordisk; Bayer Corporation; Bristol-Myers Squibb Company; Hoechst; Eli Lilly and Company; Lipha; and Farmitalia Carlo Erba; and other companies, including Boehringer-Mannheim, Becton Dickinson and Company, Owen Mumford, Securicor, Kodak, and Cortecs Diagnostics.
Requests for Reprints: United Kingdom Prospective Diabetes Study Group, Diabetes Research Laboratories, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, United Kingdom.
Current Author Addresses: Drs. Turner, Cull, and Holman: United Kingdom Prospective Diabetes Study Group, Diabetes Research Laboratories, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, United Kingdom.
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  W T. Cade Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting Physical Therapy, November 1, 2008; 88(11): 1322 - 1335. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Schwartz and A. Chadha Type 2 Diabetes Mellitus in Childhood: Obesity and Insulin Resistance J Am Osteopath Assoc, September 1, 2008; 108(9): 518 - 524. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. K. Campbell and J. R. White Jr More Choices Than Ever Before: Emerging Therapies for Type 2 Diabetes The Diabetes Educator, May 1, 2008; 34(3): 518 - 534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Peragallo-Dittko Removing Barriers to Insulin Therapy The Diabetes Educator, March 1, 2007; 33(Supplement_3): 60S - 65S. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Costa, M. Borges, C. David, and A. Vaz Carneiro Efficacy of lipid lowering drug treatment for diabetic and non-diabetic patients: meta-analysis of randomised controlled trials BMJ, May 13, 2006; 332(7550): 1115 - 1124. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. F. Van Gaal, I. L. Mertens, and D. Ballaux What is the relationship between risk factor reduction and degree of weight loss? Eur. Heart J. Suppl., November 1, 2005; 7(suppl_L): L21 - L26. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Finer Does pharmacologically induced weight loss improve cardiovascular outcome? Impact of anti-obesity agents on cardiovascular risk factors Eur. Heart J. Suppl., November 1, 2005; 7(suppl_L): L32 - L38. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Zander, A. Christiansen, S. Madsbad, and J. Juul Holst Additive Effects of Glucagon-Like Peptide 1 and Pioglitazone in Patients With Type 2 Diabetes Diabetes Care, August 1, 2004; 27(8): 1910 - 1914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. L. Fanning, B. J. Selwyn, A. C. Larme, and R. A. DeFronzo Improving Efficacy of Diabetes Management Using Treatment Algorithms in a Mainly Hispanic Population Diabetes Care, July 1, 2004; 27(7): 1638 - 1646. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. B. Degn, C. B. Juhl, J. Sturis, G. Jakobsen, B. Brock, V. Chandramouli, J. Rungby, B. R. Landau, and O. Schmitz One Week's Treatment With the Long-Acting Glucagon-Like Peptide 1 Derivative Liraglutide (NN2211) Markedly Improves 24-h Glycemia and {alpha}- and {beta}-Cell Function and Reduces Endogenous Glucose Release in Patients with Type 2 Diabetes Diabetes, May 1, 2004; 53(5): 1187 - 1194. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. B. Soumerai, C. Mah, F. Zhang, A. Adams, M. Barton, V. Fajtova, and D. Ross-Degnan Effects of Health Maintenance Organization Coverage of Self-monitoring Devices on Diabetes Self-care and Glycemic Control Arch Intern Med, March 22, 2004; 164(6): 645 - 652. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Prevention or Delay of Type 2 Diabetes Diabetes Care, January 1, 2004; 27(90001): s47 - 47. [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Anderson, C. W.C. Kendall, and D. J.A. Jenkins Importance of Weight Management in Type 2 Diabetes: Review with Meta-analysis of Clinical Studies J. Am. Coll. Nutr., October 1, 2003; 22(5): 331 - 339. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Abraira and W. Duckworth The Need for Glycemic Trials in Type 2 Diabetes Clin. Diabetes, July 1, 2003; 21(3): 107 - 111. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Prevention or Delay of Type 2 Diabetes Diabetes Care, January 1, 2003; 26(90001): s62 - 69. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Winkler, C. Abletshauser, M. M. Hoffmann, I. Friedrich, M. W. Baumstark, H. Wieland, and W. Marz Effect of Fluvastatin Slow-Release on Low Density Lipoprotein (LDL) Subfractions in Patients with Type 2 Diabetes Mellitus: Baseline LDL Profile Determines Specific Mode of Action J. Clin. Endocrinol. Metab., December 1, 2002; 87(12): 5485 - 5490. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Prevention or Delay of Type 2 Diabetes Clin. Diabetes, July 1, 2002; 20(3): 109 - 116. [Full Text] [PDF]
|
|
|
|
 |
|
 The Prevention or Delay of Type 2 Diabetes Diabetes Spectr, July 1, 2002; 15(3): 147 - 157. [Full Text] [PDF]
|
|
|
|
|
|
S. L. Krein, S. Vijan, L. M. Pogach, M. M. Hogan, and E. A. Kerr Aspirin Use and Counseling About Aspirin Among Patients With Diabetes Diabetes Care, June 1, 2002; 25(6): 965 - 970. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Caulfield and K. D. O'Brien Cardiovascular Safety of Oral Antidiabetic Agents: The Insulin Secretagogues Clin. Diabetes, April 1, 2002; 20(2): 81 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
American Diabetes Association The Prevention or Delay of Type 2 Diabetes Diabetes Care, April 1, 2002; 25(4): 742 - 749. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Winkler, I. Friedrich, M. W Baumstark, H. Wieland, and W. Marz Pioglitazone reduces atherogenic dense low density lipoprotein (LDL) particles in patients with type 2 diabetes mellitus The British Journal of Diabetes & Vascular Disease, March 1, 2002; 2(2): 143 - 148. [Abstract] [PDF]
|
|
|
|
|
|
J. J. Caro, A. J. Ward, and J. A. O'Brien Lifetime Costs of Complications Resulting From Type 2 Diabetes in the U.S. Diabetes Care, March 1, 2002; 25(3): 476 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Wright, A.C. F. Burden, R. B. Paisey, C. A. Cull, and R. R. Holman Sulfonylurea Inadequacy: Efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the U.K. Prospective Diabetes Study (UKPDS 57) Diabetes Care, February 1, 2002; 25(2): 330 - 336. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Whittemore, S. Chase, C. L. Mandle, and S. C. Roy The Content, Integrity, and Efficacy of a Nurse Coaching Intervention in Type 2 Diabetes The Diabetes Educator, November 1, 2001; 27(6): 887 - 898. [Abstract] [PDF]
|
|
|
|
|
|
R M Ewart, R. R Holman, D. R Matthews, and T. Meade The case against aggressive treatment of type 2 diabetes: critique of the UK prospective diabetes study Commentary: UKPDS is well designed and clinically important BMJ, October 13, 2001; 323(7317): 854 - 858. [Full Text] [PDF]
|
|
|
|
|
|
L. Zhang, G. Krzentowski, A. Albert, and P. J. Lefebvre Risk of Developing Retinopathy in Diabetes Control and Complications Trial Type 1 Diabetic Patients With Good or Poor Metabolic Control Diabetes Care, July 1, 2001; 24(7): 1275 - 1279. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. C. Duckworth, M. McCarren, and C. Abraira Glucose Control and Cardiovascular Complications: The VA Diabetes Trial Diabetes Care, May 1, 2001; 24(5): 942 - 945. [Full Text]
|
|
|
|
|
|
J. Pearson and R. Bergenstal Fine-Tuning Control: Pattern Management Versus Supplementation: View 1: Pattern Management: an Essential Component of Effective Insulin Management Diabetes Spectr, April 1, 2001; 14(2): 75 - 78. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Barrett-Connor and D. L Wingard ""Normal"" blood glucose and coronary risk BMJ, January 6, 2001; 322(7277): 5 - 6. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Campbell Management of Type 2 Diabetes in the Geriatric Patient Journal of Pharmacy Practice, August 1, 2000; 13(4): 263 - 276. [Abstract] [PDF]
|
|
|
|
 |
|
 B. M. Psaty, N. S. Weiss, C. D. Furberg, T. D. Koepsell, D. S. Siscovick, F. R. Rosendaal, N. L. Smith, S. R. Heckbert, R. C. Kaplan, D. Lin, et al. Surrogate End Points, Health Outcomes, and the Drug-Approval Process for the Treatment of Risk Factors for Cardiovascular Disease JAMA, August 25, 1999; 282(8): 786 - 790. [Full Text] [PDF]
|
|
|
|
|
|
R. C. Turner, C. A. Cull, V. Frighi, R. R. Holman, and for the UK Prospective Diabetes Study Group Glycemic Control With Diet, Sulfonylurea, Metformin, or Insulin in Patients With Type 2 Diabetes Mellitus: Progressive Requirement for Multiple Therapies (UKPDS 49) JAMA, June 2, 1999; 281(21): 2005 - 2012. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. D. Kanters, J.-D. Banga, R. P Stolk, and A. Algra Incidence and determinants of mortality and cardiovascular events in diabetes mellitus: a meta-analysis Vascular Medicine, May 1, 1999; 4(2): 67 - 75. [Abstract] [PDF]
|
|
|
|
|
|
M. Wei, E. S. Freedland, J. Q. Purnell, and J. D. Brunzell Excessive Weight Gain and Effects on Lipids With Intensive Therapy of Type 1 Diabetes JAMA, December 16, 1998; 280(23): 1991 - 19921. [Full Text] [PDF]
|
|
|
|
|
|
R C Turner, H Millns, H A W Neil, I M Stratton, S E Manley, D R Matthews, and R R Holman Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23) BMJ, March 14, 1998; 316(7134): 823 - 828. [Abstract] [Full Text]
|
|
|
|
|
|
B. Gaster and I. B. Hirsch The Effects of Improved Glycemic Control on Complications in Type 2 Diabetes Arch Intern Med, January 26, 1998; 158(2): 134 - 140. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Colwell Controlling Type 2 Diabetes Are the Benefits Worth the Costs? JAMA, November 26, 1997; 278(20): 1700 - 1700. [Abstract] [PDF]
|
|
|
|
|
|
S. Dagogo-Jack and J. V. Santiago Pathophysiology of Type 2 Diabetes and Modes of Action of Therapeutic Interventions Arch Intern Med, September 8, 1997; 157(16): 1802 - 1817. [Abstract] [PDF]
|
|
|
|
|
|
R. I. Shorr, W. A. Ray, J. R. Daugherty, and M. R. Griffin Incidence and Risk Factors for Serious Hypoglycemia in Older Persons Using Insulin or Sulfonylureas Arch Intern Med, August 11, 1997; 157(15): 1681 - 1686. [Abstract] [PDF]
|
|
|
|
|
|
R. Bressler and D. G. Johnson Pharmacological Regulation of Blood Glucose Levels in Non--Insulin-Department Diabetes Mellitus Arch Intern Med, April 28, 1997; 157(8): 836 - 848. [Abstract] [PDF]
|
|
