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Intensive glucose control after diagnosis of type 2 diabetes has long-term benefits

10 September 2008 

30-year Results of the UK Prospective Diabetes Study presented at the 44th European Association for the Study of Diabetes (EASD) meeting, Rome, Italy

Improved blood glucose control in type 2 diabetes leads to greater benefits in the longer term, a 30-year, large-scale UK study by Oxford University has shown. The findings, to be published in the New England Journal of Medicine, show the need to treat blood glucose levels more intensively from the time type 2 diabetes is diagnosed.

The researchers at the Oxford Centre for Diabetes, Endocrinology and Metabolism have found that earlier improved blood glucose control reduces the risk of heart attacks and leads to fewer deaths, in addition to reducing the risk of well-recognised complications from type 2 diabetes, such as kidney and eye disease.

The UK Prospective Diabetes Study (UKPDS) was the first large scale trial to show that the complications of type 2 diabetes, including kidney failure and vision loss from eye disease, were not inevitable but could be prevented, both by more intensive blood glucose control and by tighter blood pressure control. The trial results, published in 1998, changed diabetes management worldwide and now form the basis of all diabetes treatment guidelines. When the UKPDS finished all patients returned to their usual healthcare. Investigators continued to monitor them each year for diabetic complications but were no longer involved in treatment decisions.

New results published today show that although the blood glucose control differences maintained between groups during the trial disappeared rapidly, the advantages of earlier improved blood glucose control with respect to diabetic eye disease and kidney disease were undiminished even after ten years – a legacy effect. In addition, major new benefits emerged with a reduced risk of heart attacks (15%) and fewer deaths (13%).

‘We now know not only that good glucose control from the time type 2 diabetes is diagnosed reduces the rate of diabetic complications but also that this early intervention leads to sustained benefits in the longer term – a legacy effect,’ commented Professor Rury Holman of Oxford University, Chief Investigator of the study. ‘These results emphasise the importance of detecting and treating diabetes at the earliest opportunity and the major benefits that can be obtained with good blood glucose control.’

The UKPDS post-trial blood pressure results did not show a legacy effect. Blood pressure differences maintained during the trial between the tight and less-tightly controlled groups disappeared rapidly, as for blood glucose control. In this case, however, the risks of diabetic complications also become similar. The investigators concluded that lowering blood pressure remains essential to help minimise the risk of diabetic complications, but unlike glucose lowering, the benefits obtained do not increase over time.

Professor David Matthews, Chairman of the Oxford Centre for Diabetes, Endocrinology and Metabolism, added: ‘With glucose control it matters how well you are treated now and how well you were treated in the past – with blood pressure it seems to be related just to current therapy, confirming how essential it is to maintain good blood pressure levels over time if the risk of complications is to be minimised.’

Professor Andrew Neil, University of Oxford Division of Public Health & Primary Health Care, stated: ‘UKPDS is landmark trial that defined the basis for treating type 2 diabetes and has now underscored the need for lifelong good management of blood glucose and blood pressure control.’

Full results of the UKPDS post-trial follow-up will be published online in the New England Journal of Medicine on Wednesday 10th September 2008. Slides of the presentation will be available at http://www.dtu.ox.ac.uk/ukpds

For more information please contact the Press Office, University of Oxford, 01865 280528, press.office@admin.ox.ac.uk.

Notes for Editors

  • The UK Prospective Diabetes Study (UKPDS) was a landmark randomized, prospective, multicentre trial which demonstrated that improved glucose control in patients with newlydiagnosed type 2 diabetes reduced risk of clinically-evident microvascular complications, with a non-significant 16% relative risk reduction for myocardial infarction (P=0.052). In overweight patients (>120% ideal body weight) randomized primarily to metformin, substantial risk reductions for myocardial infarction (39%, P=0.01) and all-cause mortality (36%, P=0.011) were observed. An embedded Hypertension in Diabetes Study (HDS) showed that tight, compared with the less-tight blood pressure control, reduced the overall risk of complications by 24%, diabetes-related deaths by 32% and microvascular complications by 37%. These UKPDS results, published in 1998, informed diabetes guidelines that have improved diabetes management worldwide. To date, 85 UKPDS papers have been published in a numbered series in major peer-review journals.
  • Funding for the first five years of post-trial monitoring was from the UK Medical Research Council, UK Department of Health, Diabetes UK, the British Heart Foundation and the National Institutes for Health (NEI, NIDDK) and for the final five years from Bristol-Myers Squibb, GlaxoSmithKline, Merck Serono, Novartis, Novo Nordisk and Pfizer.
  • The Diabetes Trials Unit (DTU) is the largest Academic Research Organisation (ARO) worldwide that specialises in performing diabetes-related mega trials. It designs, runs and analyses large-scale interventional outcome trials nationally and internationally, often in collaboration with other AROs and pharmaceutical companies. The DTU also undertakes major modelling and statistical programmes to utilise fully the data available from its many studies with a particular emphasis on modelling diabetes and cardiovascular disease processes. It maintains DNA, urine and plasma biobanks and facilitates the genomic, proteomic and metabonomic evaluation of these materials. In addition, the DTU evaluates novel treatments and devices for the therapy of diabetes trials and undertakes research into potential new therapeutic agents. It is a fully registered UKCRC Clinical Trials Unit, runs a CPA accredited laboratory, and is a founder member of the Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM) which forms part of the 5* rated University of Oxford Nuffield Department of Medicine.
  • OCDEM (the Oxford Centre for Diabetes, Endocrinology and Metabolism) is a pioneering centre at Oxford University which combines clinical care, research and education in diabetes, endocrine and metabolic diseases. By promoting world-class research, it aims to enhance understanding of these diseases and to accelerate the search for new treatments and cures.
  • The European Association for the Study of Diabetes (EASD) is holding its 44th Annual Meeting in Rome on 8-12 September 2008.

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