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Found 291 matches for UK Prospective Diabetes
Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40. UK Prospective Diabetes Study Group.
OBJECTIVES: To estimate the economic efficiency of tight blood pressure control, with angiotensin converting enzyme inhibitors or beta blockers, compared with less tight control in hypertensive patients with type 2 diabetes. DESIGN: Cost effectiveness analysis incorporating within trial analysis and estimation of impact on life expectancy through use of the within trial hazards of reaching a defined clinical end point. Use of resources driven by trial protocol and use of resources in standard clinical practice were both considered. SETTING: 20 hospital based clinics in England, Scotland, and Northern Ireland. SUBJECTS: 1148 hypertensive patients with type 2 diabetes from UK prospective diabetes study randomised to tight control of blood pressure (n=758) or less tight control (n=390). MAIN OUTCOME MEASURE: Cost effectiveness ratios based on (a) use of healthcare resources associated with tight control and less tight control and treatment of complications and (b) within trial time free from diabetes related end points, and life years gained. RESULTS: Based on use of resources driven by trial protocol, the incremental cost effectiveness of tight control compared with less tight control was cost saving. Based on use of resources in standard clinical practice, incremental cost per extra year free from end points amounted to pound1049 (costs and effects discounted at 6% per year) and pound434 (costs discounted at 6% per year and effects not discounted). The incremental cost per life year gained was pound720 (costs and effects discounted at 6% per year) and pound291 (costs discounted at 6% per year and effects not discounted). CONCLUSIONS: Tight control of blood pressure in hypertensive patients with type 2 diabetes substantially reduced the cost of complications, increased the interval without complications and survival, and had a cost effectiveness ratio that compares favourably with many accepted healthcare programmes.
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.
UK Prospective Diabetes Study (UKPDS). VIII. Study design, progress and performance.
The UK Prospective Diabetes Study (UKPDS) is a multi-centre, prospective, randomised, intervention trial of 5100 newly-diagnosed patients with Type 2 (non-insulin-dependent) diabetes mellitus which aims to determine whether improved blood glucose control will prevent complications and reduce the associated morbidity and mortality. Newly presenting Type 2 diabetic patients aged 25-65 years inclusive, median age 53 years, median body mass index 28 kg/m2 and median fasting plasma glucose 11.3 mmol/l, were recruited and treated initially by diet. Ninety five percent remained hyperglycaemic (fasting plasma glucose greater than 6 mmol/l) and were randomly allocated to different therapies. In the main randomisation, those who were asymptomatic and had fasting plasma glucose under 15 mmol/l were allocated either to diet policy, or to active policy with either insulin or sulphonylurea aiming to reduce the fasting plasma glucose to under 6 mmol/l. Over 3 years, the median fasting plasma glucose in those allocated to diet policy was 8.9 mmol/l compared with 7.0 mmol/l in those allocated to active policy. The Hypertension in Diabetes Study has been included in a factorial design to assess whether improved blood pressure control will be advantageous. Patients with blood pressure greater than or equal to 160/90 mm Hg were randomly allocated to tight control aiming for less than 150/85 mm Hg with either an angiotensin-converting enzyme inhibitor or a Beta-blocker or to less tight control aiming for less than 200/105 mm Hg. The endpoints of the studies are major clinical events which affect the life and well-being of patients, such as heart attacks, angina, strokes, amputations, blindness and renal failure. To date, 728 patients have had at least one clinical endpoint. Surrogate endpoints include indices of macrovascular and microvascular disease detected by ECG with Minnesota Coding, retinal colour photography and microalbuminuria. The studies also aim to evaluate potential risk factors for the development of diabetic complications such as smoking, obesity, central adiposity, plasma LDL- and HDL-cholesterol, triglyceride, insulin, urate and other biochemical variables. The studies are planned to terminate in 1994, with a median follow-up of 9 years (range 3-16 years) for the glucose study and 5 years (range 2-6 years) for the hypertension study.
The UK Prospective Diabetes Study. UK Prospective Diabetes Study Group.
The Diabetes Control and Complications Study has shown that improved blood glucose control would delay the progress of microvascular complications of diabetes. However, in patients with non-insulin-dependent diabetes mellitus, the major morbidity and mortality arises from premature cardiovascular disease. It is uncertain whether therapy aimed to improve diabetes control will prevent cardiovascular complications, and whether the available therapies, sulphonylurea, biguanides or insulin, may even have long-term deleterious side-effects. The UK Prospective Diabetes Study started in 1977 and is evaluating whether long-term therapy to improve glucose control would be advantageous in clinical practice. The study has demonstrated that it is difficult to maintain improved glucose control because of the progressive beta-cell dysfunction. The study is also evaluating whether improved control of hypertension would be advantageous. The progress of the study is summarized. The results are expected to be published in 1998.
Reporting of diabetes on death certificates using data from the UK Prospective Diabetes Study.
AIMS: To study the effect of age at death, sex, ethnic group, date of death, underlying cause of death and social class on the frequency of reporting diabetes on death certificates in known cases of diabetes. METHODS: Data were extracted from certificates recording 981 deaths which occurred between 1985 and 1999 in people aged 45 years or more who participated in the UK Prospective Diabetes Study, to which 23 English, Scottish and Northern Ireland centres contributed. Diabetes (9th revision of the International Classification of Diseases; ICD-9 250) entered on parts 1A-1C or 2A-2C of the death certificate was considered as reporting diabetes. Logistic regression analyses were used to determine independent factors associated with the reporting of diabetes. RESULTS: Diabetes was reported on 42% (419/981) of all death certificates and on 46% (249/546) of those with underlying cardiovascular disease causes. Reporting of diabetes was independently associated on all death certificates with per year of age increase (OR 1.02; 95% CI 1.001-1.04, P = 0.037), underlying cause of death (non-cardiovascular causes OR 0.76; 95% CI 0.59-0.98, P = 0.035) and social class (classes I-II OR 1.00; class III OR 1.35; 95% CI 0.96-1.89, P = 0.084, classes IV-V OR 1.48; 95% CI 1.05-2.10, P = 0.027). Stratification by age, sex, and underlying cause of death also revealed significant differences in the frequency of reporting diabetes over time. CONCLUSIONS: The rate of reporting of diabetes on cardiovascular disease death certificates remains poor. This may indicate a lack of awareness of the importance of diabetes as a risk factor for cardiovascular disease.
Lessons from UK prospective diabetes study.
Type II 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. At present, it is uncertain whether Type II diabetes should be treated more intensively, with diet, tablet or insulin therapy to maintain near-normal glucose levels, in order to prevent the onset of complications. The Diabetes Control and Complications Trial (DCCT) in insulin-dependent diabetic subjects with a mean age of 27 years has indicated that intensive therapy to achieve a haemoglobin A1c level of 7.1%, compared with 9.0% in a 'standard control group', will retard the progress of diabetic microvascular disease. It is not known whether this is similarly beneficial in Type II diabetic subjects, where the main complication is cardiac disease, or whether the even better control that can be obtained with pharmaceutical therapy in Type II diabetic patients would be worthwhile. It is similarly not known whether treatment with sulphonylurea, metformin or insulin is particularly beneficial or whether any of these therapies is potentially harmful. The UK Prospective Diabetes Study (UKPDS) has randomly allocated 4209 newly diagnosed Type II diabetic patients to different therapies and is determining: (a) whether improved glucose control will delay the onset of clinical complications; and (b) whether any specific therapy has advantages or disadvantages.
UK Prospective Diabetes Study. XII: Differences between Asian, Afro-Caribbean and white Caucasian type 2 diabetic patients at diagnosis of diabetes. UK Prospective Diabetes Study Group.
Clinical and biochemical variables and prevalence of complications at diagnosis of diabetes were assessed in 5098 Type 2 diabetic patients in the UK Prospective Diabetes Study of whom 82% were white Caucasian, 10% Asian of Indian origin, and 8% Afro-Caribbean. The Asian patients were (p < 0.001) younger (mean age 52.3, 47.0, 51.0 years), less obese (BMI 29.3, 26.7, 27.9 kg m-2), had a greater waist-hip ratio, lower blood pressure (systolic 145, 139, 144, diastolic 87, 86, 89 mmHg) and prevalence of hypertension. They were more often sedentary (19, 39, 15%), more often abstained from alcohol (21, 55, 25%) and had a greater prevalence of first degree relatives with known diabetes (36, 44, 34%). The Afro-Caribbean patients had (p < 0.001) higher fasting plasma glucose (11.9, 11.3, 12.5 mmol l-1), more severely impaired beta-cell function (45, 35, 28% normal) and less impaired insulin sensitivity (23, 19, 27% normal) by homeostasis model assessment, lower triglyceride (1.8, 1.8, 1.3 mmol l-1), and higher HDL-cholesterol (1.05, 1.03, 1.17 mmol l-1). Prevalence of a history of myocardial infarction, stroke or intermittent claudication at diagnosis was similar. The prevalence of ischaemic ECG (Minnesota code), microalbuminuria (urine albumin > 50 mg l-1), retinopathy ('191' grading of retinal photographs), and neuropathy (abnormal vibration perception threshold or absent leg reflexes) was also similar. At diagnosis of Type 2 diabetes there were no differences in prevalence of complications between white Caucasian, Asian, and Afro-Caribbean patients although differences were found in other clinical and biochemical variables.
UKPDS 60: risk of stroke in type 2 diabetes estimated by the UK Prospective Diabetes Study risk engine.
BACKGROUND AND PURPOSE: People with type 2 diabetes are at elevated risk of stroke compared with those without diabetes. Relative risks have been examined in earlier work, but there is no readily available method for predicting the absolute risk of stroke in a diabetic individual. We developed mathematical models to estimate the risk of a first stroke using data from 4549 newly diagnosed type 2 diabetic patients enrolled in the UK Prospective Diabetes Study. METHODS: During 30 700 person-years of follow-up, 188 first strokes (52 fatal) occurred. Model fitting was carried out by maximum likelihood estimation using the Newton-Raphson method. Diagnostic plots were used to compare survival probabilities calculated by the model with those calculated using nonparametric methods. RESULTS: Variables included in the final model were duration of diabetes, age, sex, smoking, systolic blood pressure, total cholesterol to high-density lipoprotein cholesterol ratio and presence of atrial fibrillation. Not included in the model were body mass index, hemoglobin A1c, ethnicity, and ex-smoking status. The use of the model is illustrated with a hypothetical study power calculation. CONCLUSIONS: This model forecasts the absolute risk of a first stroke in people with type 2 diabetes using variables readily available in routine clinical practice.
UKPDS 18: estimated dietary intake in type 2 diabetic patients randomly allocated to diet, sulphonylurea or insulin therapy. UK Prospective Diabetes Study Group.
Self-reported dietary intake was estimated from 3-day prospective food diaries completed by Type 2 diabetic patients in the UK Prospective Diabetes Study. All patients had received individual dietary advice and had been randomly allocated to diet, sulphonylurea or insulin therapy 3 months after diagnosis. A total of 132 patients (120 white Caucasian, 12 Asian) stratified for gender, obesity and allocated therapy with mean age 55 years (SD 8), body mass index 28 kg m-2 (SD 4), and with a diabetes duration of 3 to 6 years were selected at random from 5 of 23 clinical centres. Patients reported a similar proportion of their energy intake as carbohydrate (43%) to the general population and had not increased to the recommended 50-55%. Their protein intake (21%) was higher than the advised 10-15%. Estimated energy intake from fat (37%) was close to that recommended for diabetic patients (30-35%) and was lower than that reported for the UK population (40%). The estimated polyunsaturated/saturated fat intake ratio (0.48) was higher than that reported for the UK population (0.35) compared with the recommended 1.0. Mean fibre intake at 22 g day-1 was less than the recommended 30 g day-1. The 8 male Asian patients took a higher proportion of their dietary intake as fat (46% vs 37%) and lower as protein (14% vs 21%) than the male white Caucasian patients. No significant differences were seen in estimated nutrient constituents between patients allocated to diet, sulphonylurea or insulin therapy as part of the UK Prospective Diabetes Study and followed for mean 4.2 years (SD1.6). This suggests that dietary factors will not confound UK Prospective Diabetes Study treatment related analyses.
UK Prospective Diabetes Study (UKPDS). XI: Biochemical risk factors in type 2 diabetic patients at diagnosis compared with age-matched normal subjects.
A total of 507, newly diagnosed, white Caucasian Type 2 diabetic patients entered into UK Prospective Diabetes Study, mean age 52 +/- 9 (SD) years have been compared with 195 age-matched normal subjects (fasting plasma glucose < 6 mmol l-1) who had no known first degree relatives with diabetes. Diabetic patients were more obese BMI(kg m-2) 30.1 +/- 6.2 vs 26.2 +/- 4.0, respectively, with female (F) diabetic patients more so than male (M). Fasting plasma glucose (mmol l-1) was 12.2 +/- 3.8 vs 5.0 +/- 0.6 in diabetic and normal subjects, and, haemoglobin A1c(%) 9.3 +/- 2.3 vs 5.4 +/- 0.4. Hyperinsulinaemia (mU l-1) was prevalent in both male and female diabetic patients, after adjustment for BMI (geometric mean 1SD interval, M 12.1 (11.8 to 12.4) vs 8.3(7.8 to 8.9) and F 13.3 (12.9 to 13.7) vs 7.4 (7.1 to 7.7). Plasma triglyceride (mmol l-1) was higher in diabetic patients, 1.8 (1.1 to 2.9) vs 1.1 (0.6 to 1.8). Total cholesterol (mmol-1) was slightly elevated in diabetic patients, with females in both populations higher than males, M 5.5 +/- 1.2 vs 5.2 +/- 0.9 and F 5.8 +/- 1.1 vs 5.5 +/- 1.1. HDL cholesterol (mmol l-1) was slightly lower in male and markedly lower in female diabetic patients than in normal subjects, M 1.00 +/- 0.26 vs 1.11 +/- 0.22 and F 1.12 +/- 0.27 vs 1.42 +/- 0.33. Urine albumin was raised in diabetic patients (mg l-1) 16.3 (5.2 to 50.9) vs 7.2 (3.2 to 16.5), as was urine N-acetylglucosaminidase (U l-1 6.4 (3.5 to 11.7) vs 2.9 (1.9 to 4.5) and plasma N-acetylglucosaminidase (U l-1) 11.5 +/- 3.2 vs 10.2 +/- 2.3. Normal subjects aged above 65 years, had slightly higher haemoglobin A1c, insulin, C-peptide, plasma and LDL cholesterol, triglyceride, plasma and urine N-acetylglucosaminidase and lower HDL cholesterol than younger subjects. The 2.5 and 97.5 percentiles for biochemical variables are presented for both populations aged 25-65 years.
Performance of the UK Prospective Diabetes Study Risk Engine and the Framingham Risk Equations in Estimating Cardiovascular Disease in the EPIC- Norfolk Cohort.
OBJECTIVE: The purpose of this study was to examine the performance of the UK Prospective Diabetes Study (UKPDS) Risk Engine (version 3) and the Framingham risk equations (2008) in estimating cardiovascular disease (CVD) incidence in three populations: 1) individuals with known diabetes; 2) individuals with nondiabetic hyperglycemia, defined as A1C >or=6.0%; and 3) individuals with normoglycemia defined as A1C <6.0%. RESEARCH DESIGN AND METHODS: This was a population-based prospective cohort (European Prospective Investigation of Cancer-Norfolk). Participants aged 40-79 years recruited from U.K. general practices attended a health examination (1993-1998) and were followed for CVD events/death until April 2007. CVD risk estimates were calculated for 10,137 individuals. RESULTS: Over 10.1 years, there were 69 CVD events in the diabetes group (25.4%), 160 in the hyperglycemia group (17.7%), and 732 in the normoglycemia group (8.2%). Estimated CVD 10-year risk in the diabetes group was 33 and 37% using the UKPDS and Framingham equations, respectively. In the hyperglycemia group, estimated CVD risks were 31 and 22%, respectively, and for the normoglycemia group risks were 20 and 14%, respectively. There were no significant differences in the ability of the risk equations to discriminate between individuals at different risk of CVD events in each subgroup; both equations overestimated CVD risk. The Framingham equations performed better in the hyperglycemia and normoglycemia groups as they did not overestimate risk as much as the UKPDS Risk Engine, and they classified more participants correctly. CONCLUSIONS: Both the UKPDS Risk Engine and Framingham risk equations were moderately effective at ranking individuals and are therefore suitable for resource prioritization. However, both overestimated true risk, which is important when one is using scores to communicate prognostic information to individuals.
UKPDS 26: Sulphonylurea failure in non-insulin-dependent diabetic patients over six years. UK Prospective Diabetes Study (UKPDS) Group.
Patients with Type 2 (non-insulin-dependent) diabetes mellitus (DM) on sulphonylurea therapy convert to insulin progressively as the sulphonylureas 'fail'. The rate of failure and the features of those who fail have been poorly described. To assess secondary failure rates of sulphonylureas, we report on the responses in 1305 patients with newly diagnosed Type 2 DM randomly allocated to therapy with either chlorpropamide or glibenclamide in the UK Prospective Diabetes Study (UKPDS). These patients were initially treated by diet for 3 months and had a fasting plasma glucose > 6 mmol l(-1); mean age 53 (SD 9) years; BMI 26.8 (SD 5.0) kg m(-2); and median fasting plasma glucose 9.1 (7.6-12.5 quartiles) mmol l(-1). If their fasting plasma glucose subsequently rose above 15.0 mmol l(-1), or they developed hyperglycaemic symptoms, additional hypoglycaemic therapy was given: metformin, ultratard insulin, and soluble insulin as required. By 6 years, 44% had required additional therapy. Of those randomized to glibenclamide, 48% required additional therapy by 6 years, compared with 40% of those allocated to chlorpropamide (p < 0.01). Sixty-one per cent, 39%, and 23%, respectively, of patients with fasting plasma glucose > or = 10.0 mmol l(-1), > or = 7.8 mmol l(-1) to < 10.0 mmol l(-1) and < 7.8 mmol l(-1) at randomization required additional therapy (p < 0.001). In the initial 3 years, non-obese subjects (BMI < 30 kg m(-2)) were more likely to require additional therapy than obese patients (BMI > or = 30 kg m(-2)) (43% vs 53% at 6 years; p < 0.001). Modelled beta-cell function showed that those with lower function were more likely to fail (p < 0.0001). Thus sulphonylureas fail as a therapeutic agent at rates which are dependent both on the phenotype at presentation and perhaps on the agent used initially. Higher failure rates were found in those with higher glucose concentrations, those who were younger, those with lower beta-cell reserve and those randomized to glibenclamide compared with chlorpropamide.
The UK Prospective Diabetes Study
The Diabetes Control and Complications Study has shown that improved blood glucose control would delay the progress of microvascular complications of diabetes. However, in patients with non-insulin-dependent diabetes mellitus, the major morbidity and mortality arises from premature cardiovascular disease. It is uncertain whether therapy aimed to improve diabetes control will prevent cardiovascular complications, and whether the available therapies, sulphonylurea, biguanides or insulin, may even have long-term deleterious side-effects. The UK prospective Diabetes Study started in 1997 and is evaluating whether long-term therapy to improve control would be advantageous in clinical practice. The study has demonstrated that it is difficult to maintain improved glucose control because of the progressive β-cell dysfunction. The study is also evaluating whether improved control of hypertension would be advantageous. The progress of the study is summarized. The results are expected to be published in 1998.
Time-varying risk of microvascular complications in latent autoimmune diabetes of adulthood compared with type 2 diabetes in adults: a post-hoc analysis of the UK Prospective Diabetes Study 30-year follow-up data (UKPDS 86).
BACKGROUND: Latent autoimmune diabetes of adulthood (LADA) differs in clinical features from type 2 diabetes. Whether this difference translates into different risks of complications remains controversial. We examined the long-term risk of microvascular complications in people enrolled in the UK Prospective Diabetes Study (UKPDS), according to their diabetes autoimmunity status. METHODS: We did a post-hoc analysis of 30-year follow-up data from UKPDS (UKPDS 86). UKPDS participants with diabetes autoantibody measurements available and without previous microvascular events were included. Participants with at least one detectable autoantibody were identified as having latent autoimmune diabetes, and those who tested negative for all autoantibodies were identified as having type 2 diabetes. The incidence of the primary composite microvascular outcome (first occurrence of renal failure, renal death, blindness, vitreous haemorrhage, or retinal photocoagulation) was compared between adults with latent autoimmune diabetes and those with type 2 diabetes. The follow-up ended on Sept 30, 2007. Baseline and updated 9-year mean values of potential confounders were tested in Cox models to adjust hazard ratios (HRs). UKPDS is registered at the ISRCTN registry, 75451837. FINDINGS: Among the 5028 participants included, 564 had latent autoimmune diabetes and 4464 had type 2 diabetes. After median 17·3 years (IQR 12·6-20·7) of follow-up, the composite microvascular outcome occurred in 1041 (21%) participants. The incidence for the composite microvascular outcome was 15·8 (95% CI 13·4-18·7) per 1000 person-years in latent autoimmune diabetes and 14·2 (13·3-15·2) per 1000 person-years in type 2 diabetes. Adults with latent autoimmune diabetes had a lower risk of the composite outcome during the first 9 years of follow-up than those with type 2 diabetes (adjusted HR 0·45 [95% CI 0·30-0·68], p<0·0001), whereas in subsequent years their risk was higher than for those with type 2 diabetes (1·25 [1·01-1·54], p=0·047). Correcting for the higher updated 9-year mean HbA1c seen in adults with latent autoimmune diabetes than in those with type 2 diabetes explained entirely their subsequent increased risk for the composite microvascular outcome (adjusted HR 0·99 [95% CI 0·80-1·23], p=0·93). INTERPRETATION: At diabetes onset, adults with latent autoimmune diabetes have a lower risk of microvascular complications followed by a later higher risk of complications than do adults with type 2 diabetes, secondary to worse glycaemic control. Implementing strict glycaemic control from the time of diagnosis could reduce the later risk of microvascular complications in adults with latent autoimmune diabetes. FUNDING: European Foundation for the Study of Diabetes Mentorship Programme (AstraZeneca).
Prospective associations of diabetes with 15 cancers in 2.2 million UK and Chinese adults.
BACKGROUND: Diabetes has been associated with the risk of numerous cancers but the causal relevance of many of these associations remains unclear. METHODS: We investigated associations between diabetes and risks of 15 cancers using Cox-regression and individual-level data from 2.2 million adults (334,978 incident cancer cases) in three prospective cohorts, UK Biobank (UKB), Million Women Study (MWS), and China Kadoorie Biobank (CKB). The potential impact of residual confounding was assessed by examining changes in diabetes-associated log-HRs after adjustment for key confounders. RESULTS: In combined analyses of individual participant data from three studies, diabetes was positively associated with the risk of 11 cancers, most notably liver (HR = 2.04, 95%CI: 1.87-2.23), pancreas (1.62, 1.48-1.77) and bladder (1.44, 1.29-1.62) cancer. The positive associations of diabetes with cancers of the breast, endometrium, kidney, and oesophageal adenocarcinoma, were substantially attenuated (>50%) after adjustment for confounders. The risks were similar in UK and Chinese populations except for liver cancer, for which the adjusted HR was greater in UK than Chinese adults (2.58 [2.28-2.92] vs 1.61 [1.43-1.83]; Phet=2.5x10-6). For liver cancer, the excess risk associated with diabetes increased with increasing BMI (Ptrend=2.7x10-4) and alcohol intake (Ptrend=0.02). Diabetes was inversely associated with incidence of prostate cancer (0.78 [0.73-0.85]) but positively associated with mortality (1.25 [1.00-1.55]). CONCLUSIONS: Diabetes increases the risk of liver, pancreatic, and bladder cancer in UK and Chinese populations. It may also have a lesser effect on stomach, colorectal cancer, and leukaemia but its associations with other cancers could well be explained by confounding and/or other biases.
Microaneurysms in the development of diabetic retinopathy (UKPDS 42). UK Prospective Diabetes Study Group.
AIMS/HYPOTHESIS: To determine whether microaneurysms, in the absence of other lesions, have a predictive role in the progression of diabetic retinopathy in Type II (non-insulin-dependent) diabetes mellitus. METHODS: Retinal photographs taken at diagnosis in patients participating in the United Kingdom Prospective Diabetes Study, and thereafter at 3 yearly intervals, were assessed using a modified Early Treatment of Diabetic Retinopathy grading system for lesions of diabetic retinopathy and end points of vitreous haemorrhage and photocoagulation. The number of microaneurysms in each eye was recorded. RESULTS: The changes between diagnosis and later photographs were analysed in 2424 patients at 6 years, 1236 at 9 years and 414 at 12 years. Of the 2424 patients studied in the 6 year cohort 1809 had either no retinopathy or microaneurysms only at entry. In these patients the presence of microaneurysms alone and also the number of microaneurysms had a high predictive value for worsening retinopathy at 3, 6, 9, and 12 years after entry into the study (e. g. at 6 years chi(2) for trend = 75 on 1 df, p < 0.001). The predictive value of the presence or absence of microaneurysms and their number at 3 years from diagnosis and subsequent worsening retinopathy was similar to that at entry. CONCLUSION/INTERPRETATION: Microaneurysms are important lesions of diabetic retinopathy and even one or two microaneurysms in an eye should not be regarded as unimportant.
UK Prospective Diabetes Study (UKPDS). IX: Relationships of urinary albumin and N-acetylglucosaminidase to glycaemia and hypertension at diagnosis of type 2 (non-insulin-dependent) diabetes mellitus and after 3 months diet therapy.
In 672 newly-diagnosed, Type 2 (non-insulin-dependent) diabetic patients without urinary infection, aged 51 (9) years, mean (1 SD), 28% of patients had raised albuminuria, defined as albumin excretion greater than 25 mg/l and 66% raised urinary N-acetylglucosaminidase excretion defined as greater than 300 mumol.h-1.l-1 (both urinary analytes corrected by linear regression on urinary creatinine to 10 mmol/1). In a univariate analysis, urinary N-acetylglucosaminidase and albumin excretion correlated with each other (rs = 0.42, p < 0.001), and with fasting plasma glucose (rs = 0.46 and rs = 0.27, p < 0.001, respectively). The association of urinary albumin and N-acetylglucosaminidase remained significant after taking the fasting plasma glucose levels into account, partial rs = 0.34, p < 0.001. After 3 months of dietary therapy BMI decreased from 29.7 (5.9) kg/m2 to 28.8 (5.8) kg/m2, fasting plasma glucose levels from 12.2 (3.8) mmol/l to 9.8 (3.8) mmol/l, and systolic blood pressure from 143 (21.8) mmHg to 131 (20.3) mmHg, p < 0.001 for each variable. There were concomitant decreases in urinary N-acetylglucosaminidase, geometric mean (1 SD interval), 397 mumol.h-1.l-1 (216 to 728) to 291 mumol.h-1.l-1 (160 to 528), p < 0.001 and in albumin excretion 16 mg/l (5 to 51) to 13 mg/l (4 to 40), p < 0.001. The decrease in urinary N-acetylglucosaminidase, but not the decrease in urinary albumin excretion, was associated with the initial degree of glycaemia and the decrease in glycaemia in response to diet.(ABSTRACT TRUNCATED AT 250 WORDS)