Before UKPDS, Doctors 'Let Diabetes Rip'
Before UKPDS, Doctors 'Let Diabetes Rip'
The background is that people, even then, weren't sure whether good glycemic control was worthwhile. One of my colleagues once said to me that he allowed patients to continue to have glycosuria. He said to "let the diabetes rip," because they will be able to lose some weight before they begin treatment. So the study was set up to ask whether it mattered to control glycemia, and if so, whether insulin or a sulfonylurea was preferred.
The results were quite astounding. First of all, it was absolutely apparent that the intensive-treatment arm was doing much better than the conventional arm, and that was significant for microvascular disease and borderline significant for cardiovascular disease. But even so, the effect sizes were running at 32% and 16%, respectively, for the difference between the conventional and the intensive therapy.
It answered the question once and for all, saying that you can't just leave people with diabetes to run high blood sugars. It will cause harm and they will get retinopathy and nephropathy. The study carried on for 10 years.
Beyond 10 years, we couldn't see all these patients every 3 months, but we kept in contact with them. Ten years later, we were able to take another look and ask them how they had done after they finished with the UKPDS trial.
The answer was again astounding. The people who had been in the intensive group initially (and after 10 years we had no control over the way that they were treated) were still doing better than the people who had been in the conventional arm. In other words, early treatment mattered. It was what made the difference, and the differences persisted.
Rory Holman set up the hypertension diabetes study (HDS), which was the embedded study in the Latin square design. Did it matter to treat hypertension? In the people who were diagnosed as having hypertension as well as diabetes, systolic blood pressure was reduced by 10 mm Hg and diastolic blood pressure by 5 mm Hg. The outcome of that study was also astounding in that there was a huge effect on macrovascular disease, microvascular disease, and mortality. So we knew from the UKPDS and HDS how important it was to undertake this treatment.
Astounding Results
The background is that people, even then, weren't sure whether good glycemic control was worthwhile. One of my colleagues once said to me that he allowed patients to continue to have glycosuria. He said to "let the diabetes rip," because they will be able to lose some weight before they begin treatment. So the study was set up to ask whether it mattered to control glycemia, and if so, whether insulin or a sulfonylurea was preferred.
The results were quite astounding. First of all, it was absolutely apparent that the intensive-treatment arm was doing much better than the conventional arm, and that was significant for microvascular disease and borderline significant for cardiovascular disease. But even so, the effect sizes were running at 32% and 16%, respectively, for the difference between the conventional and the intensive therapy.
It answered the question once and for all, saying that you can't just leave people with diabetes to run high blood sugars. It will cause harm and they will get retinopathy and nephropathy. The study carried on for 10 years.
Beyond 10 years, we couldn't see all these patients every 3 months, but we kept in contact with them. Ten years later, we were able to take another look and ask them how they had done after they finished with the UKPDS trial.
The answer was again astounding. The people who had been in the intensive group initially (and after 10 years we had no control over the way that they were treated) were still doing better than the people who had been in the conventional arm. In other words, early treatment mattered. It was what made the difference, and the differences persisted.
Rory Holman set up the hypertension diabetes study (HDS), which was the embedded study in the Latin square design. Did it matter to treat hypertension? In the people who were diagnosed as having hypertension as well as diabetes, systolic blood pressure was reduced by 10 mm Hg and diastolic blood pressure by 5 mm Hg. The outcome of that study was also astounding in that there was a huge effect on macrovascular disease, microvascular disease, and mortality. So we knew from the UKPDS and HDS how important it was to undertake this treatment.