United Kingdom Prospective Diabetes Study

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United Kingdom Prospective Diabetes Study

The United Kingdom Prospective Diabetes Study (UKPDS) was the largest and longest study of adults with type 2 diabetes. It began in 1977 to determine whether treatments that reduced blood sugar levels to near-normal levels would decrease the risk of the development or progression of long-term diabetic complications, such as eye, heart, kidney, blood vessel, and nerve disease.

The treatments included in the study were first- or second-generation sulfonylurea oral diabetes medicines, insulin, and another oral diabetes medicine called metformin. The study found that:¹

• All treatments were better than diet alone at reducing blood sugar levels.
• All treatments were equally effective at reducing blood sugar levels.
• In order to keep blood sugar levels near normal, additional medicines or insulin needed to be added about every 4 years.

The study also examined the advantages and disadvantages of the specific treatments.

• Sulfonylurea medications or insulin decreased the risk of diabetic retinopathy and diabetic nephropathy.
• Metformin decreased the risk of heart attack and death from diabetes-related conditions in people who were overweight.² These people did not gain additional weight while taking metformin. People using diet alone, taking other medicines, or taking insulin did gain weight.

People in the study who had type 2 diabetes and high blood pressure were divided into two groups. For one group, the goal was to keep blood pressure levels below 180/105 millimeters of mercury (mm Hg). For the other group, the goal was levels below 150/85 mm Hg with medicine (tightly controlled). Results showed that tightly controlled blood pressure reduced the risk of:³

• Death from diabetes.
• Complications from diabetes.
• Progression of diabetic retinopathy and declining eyesight.

In addition, the study found that the pancreas of people with type 2 diabetes gradually produced less and less insulin over time, increasing the person's need for additional medicines and eventually insulin.⁴

References

Citations

1. Turner RC (1998). The U.K. Prospective Diabetes Study: A review. Diabetes Care, 21(Suppl 3): C35–C38.

2. Lebowitz HE (2005). Management of hyperglycemia with oral antihyperglycemic agents in type 2 diabetes. In CR Kahn et al., eds., Joslin's Diabetes Mellitus, 14th ed., pp. 687–710. Philadelphia: Lippincott Williams and Wilkins.

3. Turner R, et al. (1998). Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ, 317(7160): 703–713.

4. Turner RC, et al. (1999). Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: Progressive requirement for multiple therapies (UKPDS 49). JAMA, 281(21): 2005–2012.

Credits

Last updated:	July 28, 2008
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	Michael J. Sexton, MD - Pediatrics, Stephen LaFranchi, MD - Pediatrics and Pediatric Endocrinology
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC