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From the Editor

June, 2016

  • 28 June

    June 28, 2016

    dave

    Typically our diabetes patients have changes in vision and they totally ignore them. They blame it on age, environment, old glasses and any other excuse. We as medical professionals don’t stress the possible changes enough because we are more focused on things like neuropathy and kidney failure. This means that ...

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June, 2016

Test Your Knowledge

Question #839

During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes were assigned to the intensive treatment arm (received a sulfonylurea or insulin, or metformin if overweight) or a conventional treatment arm (dietary interventions only). In the intensive treatment arm, which one of the following benefits became apparent only when a 10-year follow-up study was conducted?

Correct

Answer: C. Reduced risk of myocardial infarction

The United Kingdom Prospective Diabetes Study (UKPDS) was designed to assess whether intensive blood-glucose control would impact not only microvascular, but also macrovascular complications in patients with type 2 diabetes. All participants (N=5102) received 3 months of dietary therapy. At the 3-month mark, those who had fasting plasma glucoses of 110-270 mg/dL (N=3867) were randomly assigned to either continue with the dietary therapy or receive more intense glycemic control (either a sulfonyurea or insulin, or in overweight individuals, metformin).

Differences in outcomes between the dietary therapy only group and the intensive treatment group were assessed through three aggregate endpoints: any diabetes-related endpoint, diabetes-related death, and all-cause mortality. The intensive regimen group had lower overall mean A1C, 12% lower risk for any diabetes-related endpoint (in this aggregate, a significant portion was due to a 25% risk reduction in microvascular endpoints), 10% lower risk for diabetes-related death, and a 6% lower risk for all-cause mortality. When compared to the dietary therapy only group, patients in the intensive treatment arm had significantly greater weight gain.

While there was a reduction in nonfatal MIs, fatal MIs, or sudden death, at that time it was concluded that intensive blood glucose control in patients with type 2 diabetes resulted in decreased risk of microvascular, but not macrovascular complications. Patient participants were followed for a 10-year period to assess the durability of the risk reductions. Although differences in A1C were lost, the risk reduction in microvascular complications was maintained. Over the 10-year period, risk reductions for myocardial infarction and death from any cause emerged.

BJCP. "The UK Prospective Diabetes Study (UKPDS): clinical and therapeutic implications for type 2 diabetes." Br J Clin Pharmacol. 1999 Nov; 48(5): 643–648. doi:  10.1046/j.1365-2125.1999.00092.

Incorrect

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