United Kingdom Prospective Diabetes Study

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United Kingdom Prospective Diabetes Study

Topic Overview

The United Kingdom Prospective Diabetes Study (UKPDS) was the largest and longest study of adults with type 2 diabetes. It began in 1977 to determine whether treatments that reduced blood sugar levels to near-normal levels would decrease the risk of the development or progression of long-term diabetic complications, such as eye, heart, kidney, blood vessel, and nerve disease.

The treatments included in the study were first- or second-generation sulfonylurea oral diabetes medicines, insulin, and another oral diabetes medicine called metformin. The study found that:1

  • All treatments were better than diet alone at reducing blood sugar levels.
  • All treatments were equally effective at reducing blood sugar levels.
  • In order to keep blood sugar levels near normal, additional medicines or insulin needed to be added about every 4 years.

The study also examined the advantages and disadvantages of the specific treatments.

  • Sulfonylurea medicines or insulin reduced the risk of diabetic retinopathy and diabetic nephropathy.
  • Metformin reduced the risk of heart attack and death from diabetes-related conditions in people who were overweight.2 These people did not gain additional weight while taking metformin. People who used diet alone, took other medicines, or took insulin did gain weight. These results have been confirmed in follow-up studies.3

People in the study who had type 2 diabetes and high blood pressure were divided into two groups. For one group, the goal was to keep blood pressure levels below 180/105 millimetres of mercury (mm Hg). For the other group, the goal was levels below 150/85 mm Hg with medicine (tightly controlled). Results showed that tightly controlled blood pressure reduced the risk of:4

  • Death from diabetes.
  • Complications from diabetes.
  • Progression of diabetic retinopathy and declining eyesight.

Also, the study found that the pancreas of people with type 2 diabetes gradually produced less and less insulin over time, increasing the person's need for additional medicines and eventually insulin.5

References

Citations

  1. Turner RC (1998). The U.K. Prospective Diabetes Study: A review. Diabetes Care, 21(Suppl 3): C35–C38.
  2. Lebowitz HE (2005). Management of hyperglycemia with oral antihyperglycemic agents in type 2 diabetes. In CR Kahn et al., eds., Joslin's Diabetes Mellitus, 14th ed., pp. 687–710. Philadelphia: Lippincott Williams and Wilkins.
  3. Holman RR, et al. (2008). 10-year follow-up of intensive glucose control in type 2 diabetes. New England Journal of Medicine, 359(15): 1577–1589.
  4. Turner R, et al. (1998). Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ, 317(7160): 703–713.
  5. Turner RC, et al. (1999). Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: Progressive requirement for multiple therapies (UKPDS 49). JAMA, 281(21): 2005–2012.

Credits

By Healthwise Staff
Primary Medical Reviewer John Pope, MD - Pediatrics
Primary Medical Reviewer Andrew Swan, MD, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer Stephen LaFranchi, MD - Pediatrics, Pediatric Endocrinology
Last Revised September 24, 2010

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