Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). We investigated whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.
|Published (Last):||18 October 2016|
|PDF File Size:||11.36 Mb|
|ePub File Size:||18.17 Mb|
|Price:||Free* [*Free Regsitration Required]|
Diabet Res Clin Pract. Therefore inan additional study was set up in over people with diabetes and a high blood pressure. Over subjects at 23 centres across dabetes UK were considered for inclusion; took part. The emphasis on aggregate end-points allowed the study outcomes to be presented in a clinically meaningful way, i.
Overweight people could also be randomised to a tablet called metformin, as an additional option.
Some people were allocated to a conventional policy, primarily with diet alone. Morbidity and mortality in diabetics in the Framingham population. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes UKPDS 34 Lancet. In addition, no larger scale studies had been done to show whether improved blood pressure control was effective. Support Center Support Center. Specific diabetic complications can also develop, due to closure of small blood vessels that can cause blindness, kidney failure and amputations.
The main questions were:.
UK Prospective Diabetes Study : Protocol
The study shows that this is not the case and that with good management, including improved blood pressure and blood glucose control, may help to make complications less common and no longer a half-expected outcome.
McCarty D, Zimnet P. These showed that intensive management was neutral in its effect, with neither an adverse or beneficial effect.
The small absolute risk reduction also needs to be estudioo with the possible effects of other risk factor interventions, e. A variety of agents was used, but blood pressure differences between treatment and control groups were comparable with the UKPDS, and protective effects were observed despite ukpde periods of follow up 2—5 years. The UKPDS showed no difference in outcome between treatments, which is at first sight reassuring, but the study was powered to assess the effects of intensive therapy in general and it is unclear whether there is adequate power in this subgroup analysis.
The study also assessed effects of intensive treatment on quality of life; no adverse effect was apparent. We compared the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional ukpvs on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a randomised controlled estucio. The ACE inhibitor was however, better tolerated.
Br J Clin Pharmacol.
UK Prospective Diabetes Study
Weight gain was significantly higher in the intensive group mean 2. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: Therapeutic implications, study limitations and outstanding questions Figures 5 — 7.
These two approaches have now been shown to be the key to maintaining the health of patients. Collins R, Macmahon S. All analyses were by intention to treat and frequency of hypoglycaemia was also analysed by actual therapy.
After 10 years of diabetes, the people with diabetes in the study had a 2-fold greater mortality than the general population. Myocardial infarction was reduced by a fifth, but this was not statistically significant.
In a large American study DCCT sstudio published which showed a close relationship between control of Type 1 diabetes and the risk of complications from small vessel disease.
The “complications” can arise from damage to large arteries that cause heart attacks and strokes. To date, the effectiveness of insulin and oral hypoglycaemic agent combinations is not known, although there are unpublished data from the study on the combination of insulin and sulphonylureas. What was achievable and acceptable to a trial population cannot be necessarily translated to everyone with type 2 diabetes.
Thus there is no doubt of the significance of blood pressure control diabeted type 2 diabetes, but there remains the question whether particular drugs have advantages or disadvantages.
Estuido protective effects in diabetic nephropathy. The results were primarily expressed in terms of aggregate end points: The fact that benefits are achieved within 2 or 3 years means that all patients should be treated irrespective of age. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions.
Over 10 years, haemoglobin A1c HbA1c was 7. Intensive treatment often results in hyperinsulinaemia, with weight gain diabets an increase in hypoglycaemia [ 9 ], both of which have theoretical adverse effects on macrovascular disease, the major life threatening complication of type 2 diabetes. This is reassuring in implementing the results of the study, though the results may not apply equally to an unselected population.
Intensive blood-glucose control by either sulphonylureas or insulin substantially decreases the risk of microvascular complications, but not macrovascular disease, eestudio patients with type 2 diabetes.
One-third of patients allocated esfudio tight control required three more drugs in the attempt to achieve the target blood pressure. One aspect of management inadequately addressed by the study is the optimal combination of drugs to be used either for glucose or blood pressure control. Others were allocated to an intensive policy group aiming for near-normal glucose control, with two different sulphonylureas tablets or to insulin.