Early glucose control in type 2 diabetes reduces complications and prolongs life

A study by scientists from the Universities of Oxford and Edinburgh has found that early good control of blood glucose levels can minimise the lifelong risk of diabetes-related complications such as heart attacks, kidney failure and vision loss.

These latest results from the UK Diabetes Study (UKPDS), one of the longest running clinical trials in type 2 diabetes, were made possible by the inclusion of NHS data.

Professor Ruri Holman, from the Radcliffe Department of Medicine, University of Oxford, founder and director of the University's Diabetes Clinical Research Unit and principal investigator of the UKPDS, said: "These remarkable results highlight the critical importance of early detection and intensive treatment of type 2 diabetes."

"People can have type 2 diabetes for several years before it is diagnosed, as they may not experience significant symptoms until their blood sugar levels become significantly elevated."

A 20-year study has led to changes in global recommendations for blood glucose control Since 1977, the UKPDS has randomly allocated people with newly diagnosed type 2 diabetes to either a strategy of intensive blood glucose control using sulphonylureas, insulin or metformin, or a strategy of usual blood glucose control, mainly through diet.

Results from a 20-year study published in 1998 showed that good blood glucose control reduced the risk of diabetes complications. As a result, the UKPDS changed its guidelines worldwide, recommending intensive blood glucose control for all people with type 2 diabetes.

"This meant that the treatment and blood glucose levels in the two UKPDS groups quickly became similar," explains Professor Holman.

"Despite this, a 10-year follow-up study after the trial ended, published in 2008, found that those allocated to early intensive blood glucose control continued to experience fewer diabetes complications compared with those allocated to conventional blood glucose control."

Ongoing benefits described as 'legacy' effect New findings show that the legacy effect of introducing intensive blood glucose control immediately after diabetes diagnosis persists for up to 24 years after the trial ended.

Early intensive control of blood glucose with insulin injections or sulphonylurea tablets resulted in a 10% reduction in deaths, a 17% reduction in heart attacks and a 26% reduction in diabetes complications such as kidney failure and vision loss. Early intensive control of blood glucose with metformin resulted in a 31% reduction in heart attacks and a 20% reduction in deaths. The treatments used in the UKPDS remain widely used worldwide at low cost.

The paper, "Post-trial follow-up of the randomised controlled trial of intensive blood glucose control in type 2 diabetes extended from 10 to 24 years (UKPDS 91)" was presented at the 67th meeting of the Japanese Diabetes Society, held from 17 to 19 May in Tokyo, Japan, and published in The Lancet.

Professor Amanda Adler, director of the Diabetes Clinical Research Unit, said: "This shows that early and thorough treatment of type 2 diabetes is critical. Playing catch-up with blood glucose control is not enough."

Professor Philip Clarke, director of the Centre for Health Economics Research at the University of Oxford, said: "The main lifelong benefit is the increased life expectancy of those allocated to intensive blood glucose control. The reduced incidence of many diabetes-related complications will have a positive impact on overall quality of life."

Dr Will Whiteley, Professor of Neurology and Epidemiology at the University of Edinburgh's Clinical Brain Research Centre and Deputy Director of the BHF Data Science Centre, HDRUK, added: "Following UKPDS participants for up to 42 years was only possible thanks to the rich, linked NHS data across the UK."

"This allowed us to study the impact of treatments given in midlife on diseases of ageing such as dementia. It shows the value of using NHS data for clinical trials."