The recent annual meeting of the European Association for the Study of Diabetes (EASD) in Barcelona took place 15 years after it was last held there, that conference being remembered for the publication of the ground breaking results from the UKPDS study. Running from 1977 – 1991 with patients being followed for approximately 10 years, it changed the way in which Type 2 diabetes is now treated. It was the first large study to recruit patients with recently diagnosed diabetes and assign them into a conventional and intensive treatment arm – at a time when it was unclear whether glycaemic control was actually important and if so, what was the impact of specific treatments (Sulphonylureas, Metformin or insulin).
The blood glucose arm of the study eventually demonstrated that improving glycaemic control by 0.9% in patients recently diagnosed with Type 2 diabetes significantly reduced the risk of microvascular disease by 25% and myocardial infarction by 16% (well, almost p=0.052).A t the same time, the blood pressure arm which lowered BP by 10/5 significantly reduced the risks of virtually all cardiovascular and microvascular outcomes, with risk reductions ranging from 24 to 56%.
Various other facts now taken for granted came out of UKPDS including a clearer understanding of the progressive nature of diabetes (β cell failure) and the impressive impact of Metformin which significantly reduced myocardial infarction. Following this, Metformin has become the first line drug treatment for diabetes – even though there were only 342 patients in this group.
The legacy results from UKPDS showed that even though the difference in control between the intensive and conventional groups disappeared, reduction in complications still persisted in the intensive group – including the now significant myocardial infarction results.
It is clear that with more than 37,000 citations of the results that UKPDS continue to define the way that Type 2 diabetes is treated.
Dr. Mark Freeman