44-year UKPDS Legacy Effects Presented at the EASD


The 44-year UK Prospective Diabetes Study (UKPDS) follow-up results were presented today at the 58th Annual Meeting of the European Association for the Study of Diabetes (EASD) in Stockholm, Sweden. The new data from the UKPDS, one of the longest ever studies of diabetes, show that the problems experienced by people with type 2 diabetes, including heart attacks, kidney failure and vision loss are not inevitable, with the benefits of early good blood glucose control persisting for decades.

Starting in 1977, the UKPDS randomly allocated people with newly-diagnosed type 2 diabetes to an intensive blood glucose control strategy with sulfonylureas, insulin or metformin, or to a conventional blood glucose control strategy, primarily with diet. The 20-year trial results, published in 1998, showed that good blood glucose control reduced the risk of diabetic complications. Worldwide, UKPDS changed guidelines to recommend intensive blood glucose control for everyone with type 2 diabetes. This meant that the therapies and blood glucose levels in the two UKPDS groups rapidly became similar. Despite this convergence, the 10-year post-study follow-up analysis, published in 2008, showed the reduction in the risk of diabetic complications continued for up to 30 years, a legacy effect of early intensive blood glucose control.

The new results show that the legacy effects of implementing intensive blood glucose control straight after diagnosis continue to persist for up to 44 years. Early intensive blood glucose control with insulin injections or sulfonylurea tablets led to 11% fewer deaths and 26% fewer diabetic complications such as kidney failure and vision loss. Early intensive blood glucose control with metformin led to 31% fewer heart attacks and 25% fewer deaths.

Professor Rury Holman, the founding Director of the University of Oxford Diabetes Trials Unit and Chief Investigator of the UKPDS, said 'These remarkable findings emphasise the critical importance of detecting and treating type 2 diabetes intensively at the earliest possible opportunity.'

Professor Amanda Adler, Director of the Diabetes Trial Unit and Clinical Epidemiologist of the UKPDS, said, 'This shows that treating type 2 diabetes early and thoroughly is crucial. Playing catch-up with blood glucose control is not sufficient.'

Professor Philip Clarke, Director of the University of Oxford Health Economics Research Centre, said 'A major life-time benefit is the increase life-expectancy by around 1-2 years for those allocated to intensive blood glucose control. The reduced rate of many diabetes-related complications will have a positive impact on overall quality of life'.

Dr Will Whiteley, Reader in Neurology at the University of Edinburgh Centre for Clinical Brain Sciences, and Senior Research Fellow at the University of Oxford MRC Centre for Population Health said 'Following up people from the UKPDS for up to 44 years was possible only with the rich linked NHS data sources across UK nations. This meant we could study the effects of treatments given in midlife on diseases of ageing, such as dementia'.