Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). We investigated whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.
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Nevertheless, the available data suggest that if more care is given to obtain both near-normal blood glucose and near-normal blood pressure levels, the benefit from each therapy would combine to give a greater reduced risk of complications than either treatment on its own. No threshold was seen, i. There is concern that sulphonylureas may increase estudo mortality in patients with type 2 diabetes and that high insulin concentrations may enhance atheroma formation.
These strengthened the study by broadening its scope, but at the cost of complicating the treatment allocation, conduct and analysis of the study. Different agents seemed equally effective, but the possibility of type 2 errors in these subgroup analyses cannot be excluded, as already discussed.
The Study was not primarily designed to answer this question. Blood pressure, antihypertensive drug treatment and the risks of stroke and coronary heart disease.
The ACE inhibitor was however, better tolerated. These two approaches have now been shown to be the key to maintaining the health of patients. Until now there has been little convincing evidence that improved diabetes control will prevent the complications of diabetes. The study was subsequently extended to 23 sites. Health Survey for England Unlike glycaemic control, there was a significant effect on macrovascular as well as microvascular complications, with strokes and heart failure reduced by a half.
Intensive glucose control significantly reduced any diabetes-related end point, but had no effect on mortality. Renal protective effects in diabetic nephropathy. When diet failed to achieve these targets, subjects were randomized to sulphonylureas, insulin or metformin, the latter in obese patients only.
The rates of major hypoglycaemic episodes per year were 0. Furthermore, the benefits of glucose reduction did not accrue for several years, unlike intensive blood pressure control. The “complications” can arise from damage to large arteries that cause heart attacks and strokes.
The second statement is as true today as it was almost years ago. Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardio-vascular and diabetic complications.
All analyses were by intention to treat and frequency of hypoglycaemia was diabetea analysed by actual therapy. If not fatal they can seriously affect the quality of life.
Inthe study of treatment of hypertension was started. This must be remembered when applying the results of the study to clinical practice. In spite of insulin therapy, after a few years it can be difficult to maintain good blood glucose control.
Improved blood-glucose control decreases the progression of diabetic microvascular disease, but the effect on macrovascular complications is unknown. New methods of treating diabetes are still required.
Economic evaluations of Type II diabetes. New Eng J Med. Twenty-one single end points were also defined. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes UKPDS 33 Lancet.
The study showed that intensive blood pressure treatment is acceptable to people with diabetes, and that better blood pressure control than standard management can be obtained. Author ukpdz Article notes Copyright and License information Disclaimer.
The same endpoint ascertainment and adjudication process was used throughout to ensure analytic comparability. Therefore a study to show whether a treatment will prevent complications has to be a long-term study. These are very impressive results, establishing that blood pressure control is at least as important as glycaemic control, if not more so, in the prevention of complications in type 2 diabetes. Since medicine is djabetes art of estudjo feasible, a high priority could be given to ensuring good control of blood pressure.