What are the implications of the findings of the United Kingdom Prospective Diabetes Study (UKPDS) for management of type 2 diabetes mellitus (DM)?

Updated: Oct 23, 2019
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

Significant implications of the UKPDS findings include the following:

  • Microvascular complications (predominantly indicated by the need for laser photocoagulation of retinal lesions) are reduced by 25% when mean HbA1c is 7%, compared with 7.9%

  • A continuous relationship exists between glycemia and microvascular complications, with a 35% reduction in risk for each 1% decrement in HbA1c; a glycemic threshold (above the upper limit of normal for HbA1c) below which risk for microvascular disease is eliminated does not appear to exist

  • Glycemic control has minimal effect on macrovascular disease risk; excess macrovascular risk appears to be related to conventional risk factors such as dyslipidemia and hypertension

  • Sulfonylureas and insulin therapy do not increase macrovascular disease risk [67]

  • Metformin reduces macrovascular risk in patients who are obese [128]

  • Vigorous blood pressure control reduces microvascular and macrovascular events; beta blockers and angiotensin-converting enzyme (ACE) inhibitors appear to be equally effective in this regard


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