UK Prospective Diabetes Study
Reducing glucose exposure (HbA1c 7.0 % versus 7.9 % over median 10.0 years), with sulphonylurea or insulin therapy, reduced the risk of “any diabetes-related endpoint” by 12% and microvascular disease by 25%, with a 16% trend to a reduced risk of myocardial infarction (P=0.052). Post-UGDP (University Group Diabetes Program) fears that sulphonylurea or insulin therapies may be harmful were allayed, as no increase was observed with these agents in the incidence of cardiovascular deaths, myocardial infarction or sudden death. Although neither of these therapies impaired quality of life, both increased risk of hypoglycaemia and weight gain.
In an embedded study of 1,148 hypertensive patients, improving blood pressure (142/82 mmHg versus 154/87 mmHg over median 8.4 years) with an ACE inhibitor or a beta blocker, reduced the risk of both microvascular and macrovascular disease. A cost-effectiveness analysis showed that cost savings from the reduction in diabetic complications outweighed the cost of the additional medication required, but not the extra staff costs involved.