UK Prospective Diabetes Study

Type 2 diabetes is a major cause of morbidity and mortality, both from an increased risk of developing cardiovascular disease and from specific diabetic complications. At present, patients are often treated to prevent marked hyperglycaemia that induces symptoms such as thirst. Moderately raised glucose levels are then accepted. It is uncertain whether type 2 diabetes should be treated more intensively, with diet, tablet or insulin therapy, to maintain near-normal glucose levels and possibly prevent clinical complications. The UK Prospective Diabetes Study (UKPDS) has randomised 4209 newly diagnosed type 2 diabetic patients to different therapies, including diet, and is determining whether, compared with 'conventional therapy' primarily with diet, 'intensive therapy' to improve glucose control will be beneficial and whether specific therapy with sulphonylurea, metformin or insulin, is particularly advantageous in preventing clinical complications or potentially harmful. Over 6 years follow-up, those allocated to conventional or intensive therapies have median haemoglobin A1c 7.4% and 6.6% respectively. By 6 years 18% have had a diabetes-related clinical complication, 12% being due to macrovascular and 6% microvascular pathology. The study will terminate in 1998, when it will have 80% at α = 0.01 to detect 15% reduction in complications.