Trial backs early diabetes treatment

Researchers backed treating diabetes early after the United Kingdom Prospective Diabetes Study (UKPDS) released 10-year post monitoring data today showing long-term effects of glucose and BP control in patients with type-2 diabetes.

The landmark UKPDS trial initially followed 5,102 patients from 1977 to 1997 and showed that complications of diabetes could be reduced by improving blood glucose and/or BP control.

On completing the trial, all surviving patients were returned to community or hospital-based diabetes care according to their clinical needs, but with no attempt or intervention to maintain them on their randomised therapies.

Over a further 10-year, post-trial monitoring period, patients continued to receive annual assessment at UKPDS clinics, where possible, for a further five years. This was followed by questionnaire-based assessment with input from patients’ GPs to capture possible endpoints for an additional five years.

Results of the post-study released at the European Association for the Study of Diabetes conference in Rome showed that between 1997 and 2007, after return to usual care, relative risk reductions for MI and all-cause mortality persisted in patients who received blood glucose control during the original trial.

For MI, patients taking suphonylureas/insulin had a relative risk reduction of 16 per cent in 1997 and 15 per cent in 2007, and for all-cause mortality these figures were 6 per cent and 13 per cent.

Patients taking metformin had relative risk reductions for MI of 39 per cent in 1997 and 33 per cent in 2007, and 36 per cent and 27 per cent for all-cause mortality, respectively.

Those patients who received BP-lowering therapy during the UKPDS trial showed no ‘legacy effect’ and analysis of results suggested that the difference had gone after two years.

Researchers commented that this finding suggests that the changes to usual care guidelines following announcement of the UKPDS results in 1997 were working, and that BP-lowering treatments have their maximal beneficial effect early.

Professor Rury Holman, of the Diabetes Trials Unit at Oxford University and one of the trial investigators, said that results show that ‘if you treat diabetes early, you see extended benefits’ and that ‘you can’t wait to treat diabetes – these data recommend you start treatment with medication’ rather than lifestyle advice.

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