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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?


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.