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Image by Tesa Robbins from Pixabay
These latest results from the UK Prospective Diabetes Study (UKPDS), one of the longest ever clinical trials in type 2 diabetes, were made feasible by incorporating NHS data.
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.
‘People may have type 2 diabetes for several years before being diagnosed as they may have few symptoms until their blood sugars become substantially elevated.’
20-year trial led to worldwide guideline changes in blood glucose control
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,’ explains Professor Holman.
‘Despite this, the 10-year post-trial monitoring study, published in 2008, showed those who had been allocated to early intensive blood glucose control continued to experience fewer diabetic complications compared with those allocated to conventional blood glucose control.’
Continuing benefits described as a ‘legacy’ effect
The new results show that the legacy effects of implementing intensive blood glucose control straight after diagnosis of diabetes continue to persist for up to 24 years after the trial ended.
Early intensive blood glucose control with insulin injections or sulfonylurea tablets led to 10% fewer deaths, 17% fewer heart attacks 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 20% fewer deaths. The treatments used in the UKPDS remain in common use worldwide at low cost.
Professor Amanda Adler, Director of the Diabetes Trial Unit, 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 increased life-expectancy in 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, Professor in Neurology and Epidemiology at the University of Edinburgh Centre for Clinical Brain Sciences, and Associate Director at BHF Data Science Centre, HDRUK added: ‘Following up UKPDS participants for up to 42 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. This shows the value for clinical trials of accessing NHS data.’
The 24-year post-trial follow-up of the UK Prospective Diabetes Study is presented at the 67th Japan Diabetes Society meeting, Tokyo, Japan and published in The Lancet.