Early glucose control in type 2 diabetes reduces complications and prolongs life

The study, led by scientists from the Universities of Oxford and Edinburgh, found that good early control of blood glucose levels can minimize the lifetime risk of diabetes-related complications such as heart attacks, kidney failure and vision loss.

These are the latest results from the UK Diabetes Study (UKPDS), one of the longest-running clinical trials of type 2 diabetes, made possible by the inclusion of NHS data.

Professor Ruri Holman from the Radcliffe Department of Medicine, University of Oxford, founder and director of the university's Diabetes Clinical Research Unit and principal investigator of the UKPDS, said: "These remarkable results highlight the critical importance of early detection and intensive treatment of type 2 diabetes."

"People may have type 2 diabetes for several years before it is diagnosed because they may not experience significant symptoms until their blood sugar levels become significantly elevated."

20-year study leads to changes in global recommendations for blood glucose control Since 1977, UKPDS has randomly assigned people with newly diagnosed type 2 diabetes to an intensive blood glucose control strategy using sulfonylurea, insulin or metformin, or a strategy of conventional blood glucose control, primarily through diet.

The results of a 20-year study published in 1998 showed that good blood glucose control reduces the risk of diabetes complications. As a result, UKPDS has changed guidelines worldwide to recommend intensive blood glucose monitoring for all patients with type 2 diabetes.

“This meant that treatment and blood glucose levels in the two UKPDS groups quickly became similar,” explains Professor Holman.

"Despite this, a 10-year post-trial observational study published in 2008 found that those assigned to early intensive blood glucose control continued to experience fewer diabetes complications compared with those who were allocated to routine blood glucose monitoring."

Long-term benefits described as 'legacy effect' New findings show that the legacy effect of implementing intensive blood glucose monitoring immediately after diabetes diagnosis lasts up to 24 years after the end of the trial.

Early intensive control of blood glucose levels with insulin injections or sulfonylurea tablets led to a 10% reduction in deaths, heart attacks by 17%, and diabetes complications such as kidney failure and vision loss by 26%. Early intensive blood glucose control with metformin resulted in a 31% reduction in heart attacks and a 20% reduction in mortality. The treatments used in UKPDS remain widely used around the world at low cost.

The paper "Post-trial follow-up of a randomized controlled trial of intensive blood glucose control in type 2 diabetes extended from 10 to 24 years (UKPDS 91)" was presented at the 67th meeting of the Japan Diabetes Society, which was held from May 17 to 19 in Tokyo, Japan, and published in The Lancet.

Professor Amanda Adler, Director of the Diabetes Clinical Research Unit, said: "This shows that early and thorough treatment of type 2 diabetes is critical. Playing catch-up with blood glucose control is not enough."

Professor Philip Clarke, director of the University of Oxford's Center for Health Economics Research, said: "The main lifetime benefit is the increased life expectancy of those allocated to intensive blood glucose control. "The reduced incidence of many diabetes-related complications will have a positive impact impact on the overall quality of life."

Dr Will Whiteley, Professor of Neuroscience and Epidemiology, University of Edinburgh Clinical Brain Research Center and Deputy Director of the BHF Data Science Centre, HDRUK, added: “Following UKPDS participants for up to 42 years was only possible thanks to the wealth of linked NHS data across the UK. Kingdom."

"This allowed us to study the effect of treatments given in midlife on diseases of aging such as dementia. This shows the value of using NHS data for clinical trials."