BMJ 1998;317:703-713 ( 12 September )

Papers

Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38

Editorials by Orchard and Mogensen Papers pp   713 , 720 This paper was prepared for publication by Robert Turner, Rury Holman, Irene Stratton, Carole Cull, Valeria Frighi, Susan Manley, David Matthews, Andrew Neil, Heather McElroy, Eva Kohner, Charles Fox, David Hadden, and David Wright.

UK Prospective Diabetes Study Group. 

Correspondence to: Professor R Turner, UK Prospective Diabetes Study Group, Diabetes Research Laboratories, Radcliffe Infirmary, Oxford OX2 6HE

Objective: To determine whether tight control of blood pressure prevents macrovascular and microvascular complications in patients with type 2 diabetes.
Design: Randomised controlled trial comparing tight control of blood pressure aiming at a blood pressure of <150/85 mm Hg (with the use of an angiotensin converting enzyme inhibitor captopril or a beta  blocker atenolol as main treatment) with less tight control aiming at a blood pressure of <180/105 mm Hg.
Setting: 20 hospital based clinics in England, Scotland, and Northern Ireland.
Subjects: 1148 hypertensive patients with type 2 diabetes (mean age 56, mean blood pressure at entry 160/94 mm Hg); 758 patients were allocated to tight control of blood pressure and 390 patients to less tight control with a median follow up of 8.4 years.
Main outcome measures: Predefined clinical end points, fatal and non-fatal, related to diabetes, deaths related to diabetes, and all cause mortality. Surrogate measures of microvascular disease included urinary albumin excretion and retinal photography.
Results: Mean blood pressure during follow up was significantly reduced in the group assigned tight blood pressure control (144/82 mm Hg) compared with the group assigned to less tight control (154/87 mm Hg) (P<0.0001). Reductions in risk in the group assigned to tight control compared with that assigned to less tight control were 24% in diabetes related end points (95% confidence interval 8% to 38%) (P=0.0046), 32% in deaths related to diabetes (6% to 51%) (P=0.019), 44% in strokes (11% to 65%) (P=0.013), and 37% in microvascular end points (11% to 56%) (P=0.0092), predominantly owing to a reduced risk of retinal photocoagulation. There was a non-significant reduction in all cause mortality. After nine years of follow up the group assigned to tight blood pressure control also had a 34% reduction in risk in the proportion of patients with deterioration of retinopathy by two steps (99% confidence interval 11% to 50%) (P=0.0004) and a 47% reduced risk (7% to 70%) (P=0.004) of deterioration in visual acuity by three lines of the early treatment of diabetic retinopathy study (ETDRS) chart. After nine years of follow up 29% of patients in the group assigned to tight control required three or more treatments to lower blood pressure to achieve target blood pressures.
Conclusion: Tight blood pressure control in patients with hypertension and type 2 diabetes achieves a clinically important reduction in the risk of deaths related to diabetes, complications related to diabetes, progression of diabetic retinopathy, and deterioration in visual acuity.

Key messages

  • This study showed that tight control of blood pressure based on captopril or atenolol as first agents and aiming for both a systolic blood pressure <150 mm Hg and diastolic pressure <85 mm Hg achieved a mean 144/82 mm Hg compared with 154/87 mm Hg in a control group

  • 29% of patients in the tight control group required three or more hypotensive treatments

  • Tight control of blood pressure reduced the risk of any non-fatal or fatal diabetic complications and of death related to diabetes; deterioration in visual acuity was also reduced

  • Reducing blood pressure needs to have high priority in caring for patients with type 2 diabetes



© BMJ 1998
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Systemic management of diabetic retinopathy
Gerald Liew, Paul Mitchell, and Tien Y Wong
BMJ 2009 338: b441. [Extract] [Full Text]

Secular decline in mortality from coronary heart disease in adults with diabetes mellitus: cohort study
Ane Cecilie Dale, Lars J Vatten, Tom Ivar Nilsen, Kristian Midthjell, and Rune Wiseth
BMJ 2008 337: a236. [Abstract] [Full Text] [PDF]

Prevention and early detection of vascular complications of diabetes
Sally M Marshall and Allan Flyvbjerg
BMJ 2006 333: 475-480. [Extract] [Full Text] [PDF]

Glycaemia and vascular effects of type 2 diabetes
Brian Budenholzer, J K Cruickshank, R J Jarrett, Irene M Stratton, Carole A Cull, Susan E Manley, Amanda I Adler, H Andrew W Neil, David R Matthews, and Rury R Holman
BMJ 2001 322: 1245. [Extract] [Full Text]

Treating type 2 diabetes
K M Venkat Narayan, Gloria L A Beckles, Edward W Gregg, David F Williamson, J Saaddine, Michael M Engelgau, Frank Vinicor, Evald H Christiansen, Stefan M Groetsch, Joseph T LaVan, John W Epling, Jonathan Richards, Robert Turner, and Rury Holman
BMJ 1999 318: 666. [Extract] [Full Text]

Diabetes and death
BMJ 1998 317: 0. [Full Text]

Good news on diabetes, bad news on nose drops
BMJ 1998 317: 0. [Full Text]

Tight blood pressure control reduces risks of type 2 diabetes and is cost effective
BMJ 1998 317: 0. [Full Text]

Diabetes: a time for excitement---and concern
Trevor Orchard
BMJ 1998 317: 691-692. [Extract] [Full Text] [PDF]

Combined high blood pressure and glucose in type 2 diabetes: double jeopardy
Carl Erik Mogensen
BMJ 1998 317: 693-694. [Extract] [Full Text] [PDF]

Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39
UK Prospective Diabetes Study Group
BMJ 1998 317: 713-720. [Abstract] [Full Text] [PDF]

Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40
UK Prospective Diabetes Study Group
BMJ 1998 317: 720-726. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

  • van Bruggen, R., Gorter, K., Stolk, R., Klungel, O., Rutten, G. (2009). Clinical inertia in general practice: widespread and related to the outcome of diabetes care. Fam Pract 26: 428-436 [Abstract] [Full text]  
  • Mancia, G., Corrao, G. (2009). Targeting blood pressure in the management of total cardiovascular risk. Eur Heart J Suppl 11: F27-F32 [Abstract] [Full text]  
  • Moser, M., Feig, P. U. (2009). Fifty Years of Thiazide Diuretic Therapy for Hypertension. Arch Intern Med 169: 1851-1856 [Abstract] [Full text]  
  • Ong, H. T. (2009). Are Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Especially Useful for Cardiovascular Protection?. J Am Board Fam Med 22: 686-697 [Abstract] [Full text]  
  • Katon, W., Russo, J., Lin, E. H. B., Heckbert, S. R., Karter, A. J., Williams, L. H., Ciechanowski, P., Ludman, E., Von Korff, M. (2009). Diabetes and Poor Disease Control: Is Comorbid Depression Associated With Poor Medication Adherence or Lack of Treatment Intensification?. Psychosom. Med. 71: 965-972 [Abstract] [Full text]  
  • Zoungas, S., de Galan, B. E., Ninomiya, T., Grobbee, D., Hamet, P., Heller, S., MacMahon, S., Marre, M., Neal, B., Patel, A., Woodward, M., Chalmers, J., on behalf of the ADVANCE Collaborative Group, (2009). Combined Effects of Routine Blood Pressure Lowering and Intensive Glucose Control on Macrovascular and Microvascular Outcomes in Patients With Type 2 Diabetes: New results from the ADVANCE trial. Diabetes Care 32: 2068-2074 [Abstract] [Full text]  
  • Leibowitz, A., Grossman, E. (2009). How to Define Prehypertension in Diabetes/Metabolic Syndrome. Diabetes Care 32: S275-S279 [Full text]  
  • Grossman, E. (2009). Should We Treat Prehypertension in Diabetes?: What are the cons?. Diabetes Care 32: S280-S283 [Full text]  
  • McWilliams, J. M., Meara, E., Zaslavsky, A. M., Ayanian, J. Z. (2009). Medicare Spending for Previously Uninsured Adults. ANN INTERN MED 0: 0000605-200912010-00149v1-E-149 [Abstract] [Full text]  
  • Postma, M. J., de Zeeuw, D. (2009). The economic benefits of preventing end-stage renal disease in patients with type 2 diabetes mellitus. Nephrol Dial Transplant 24: 2975-2983 [Full text]  
  • Sabanayagam, C., Shankar, A., Saw, S. M., Tai, E. S., Lim, S. C., Lee, J. J.-M., Wong, T. Y. (2009). Prevalence of Diabetes Mellitus, Glycemic Control, and Associated Factors in a Malay Population in Singapore. Asia Pac J Public Health 21: 385-398 [Abstract]  
  • Redberg, R. F., Benjamin, E. J., Bittner, V., Braun, L. T., Goff, D. C. Jr, Havas, S., Labarthe, D. R., Limacher, M. C., Lloyd-Jones, D. M., Mora, S., Pearson, T. A., Radford, M. J., Smetana, G. W., Spertus, J. A., Swegler, E. W. (2009). ACCF/AHA 2009 performance measures for primary prevention of cardiovascular disease in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for Primary Prevention of Cardiovascular Disease) developed in collaboration with the American Academy of Family Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation; and Preventive Cardiovascular Nurses Association Endorsed by the American College of Preventive Medicine, American College of Sports Medicine, and Society for Women's Health Research.. J Am Coll Cardiol 54: 1364-1405 [Full text]  
  • WRITING COMMITTEE MEMBERS, , Redberg, R. F., Benjamin, E. J., Bittner, V., Braun, L. T., Goff, D. C. Jr, Havas, S., Labarthe, D. R., Limacher, M. C., Lloyd-Jones, D. M., Mora, S., Pearson, T. A., Radford, M. J., Smetana, G. W., Spertus, J. A., Swegler, E. W. (2009). ACCF/AHA 2009 Performance Measures for Primary Prevention of Cardiovascular Disease in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for Primary Prevention of Cardiovascular Disease): Developed in Collaboration With the American Academy of Family Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation; and Preventive Cardiovascular Nurses Association: Endorsed by the American College of Preventive Medicine, American College of Sports Medicine, and Society for Women's Health Research. Circulation 120: 1296-1336 [Full text]  
  • Kelly, T. N., Bazzano, L. A., Fonseca, V. A., Thethi, T. K., Reynolds, K., He, J. (2009). Systematic Review: Glucose Control and Cardiovascular Disease in Type 2 Diabetes. ANN INTERN MED 151: 394-403 [Abstract] [Full text]  
  • Garg, S., Davis, R. M. (2009). Diabetic Retinopathy Screening Update. Clin. Diabetes 27: 140-145 [Abstract] [Full text]  
  • Wu, D., Peng, F., Zhang, B., Ingram, A. J., Kelly, D. J., Gilbert, R. E., Gao, B., Kumar, S., Krepinsky, J. C. (2009). EGFR-PLC{gamma}1 signaling mediates high glucose-induced PKC{beta}1-Akt activation and collagen I upregulation in mesangial cells. Am. J. Physiol. Renal Physiol. 297: F822-F834 [Abstract] [Full text]  
  • Simo, R., Hernandez, C. (2009). Advances in the Medical Treatment of Diabetic Retinopathy. Diabetes Care 32: 1556-1562 [Full text]  
  • Klapholz, M. (2009). {beta}-Blocker Use for the Stages of Heart Failure. Mayo Clin Proc. 84: 718-729 [Abstract] [Full text]  
  • O'Keefe, J. H., Carter, M. D., Lavie, C. J. (2009). Primary and Secondary Prevention of Cardiovascular Diseases: A Practical Evidence-Based Approach. Mayo Clin Proc. 84: 741-757 [Abstract] [Full text]  
  • Preis, S. R., Pencina, M. J., Hwang, S.-J., D'Agostino, R. B. Sr, Savage, P. J., Levy, D., Fox, C. S. (2009). Trends in Cardiovascular Disease Risk Factors in Individuals With and Without Diabetes Mellitus in the Framingham Heart Study. Circulation 120: 212-220 [Abstract] [Full text]  
  • Holbrook, A., Thabane, L., Keshavjee, K., Dolovich, L., Bernstein, B., Chan, D., Troyan, S., Foster, G., Gerstein, H., for the COMPETE II Investigators, (2009). Individualized electronic decision support and reminders to improve diabetes care in the community: COMPETE II randomized trial. CMAJ 181: 37-44 [Abstract] [Full text]  
  • Pimlott, N. (2009). Hypertension and the family physician. cfp 55: 682-682 [Full text]  
  • Pimlott, N. (2009). L'hypertension et le medecin de famille. cfp 55: 683-683 [Full text]  
  • Tu, K. (2009). Hypertension management by family physicians: Is it time to pat ourselves on the back?. cfp 55: 684-685 [Full text]  
  • Tu, K. (2009). Prise en charge de l'hypertension par les medecins de famille: Est-ce le temps de nous feliciter?. cfp 55: 686-687 [Full text]  
  • On behalf of the Canadian Hypertension Education P, (2009). 2009 Canadian Hypertension Education Program recommendations: An annual update. cfp 55: 697-700 [Full text]  
  • Putnam, W., Buhariwalla, F., Lacey, K., Goodfellow, M., Goodine, R. A., Hall, J., MacDonald, I., Murray, M., Smith, P., Burge, F., Natarajan, N., Lawson, B. (2009). Drug management for hypertension in type 2 diabetes in family practice. cfp 55: 728-734 [Abstract] [Full text]  
  • Shea, S., Weinstock, R. S, Teresi, J. A, Palmas, W., Starren, J., Cimino, J. J, Lai, A. M, Field, L., Morin, P. C, Goland, R., Izquierdo, R. E, Ebner, S., Silver, S., Petkova, E., Kong, J., Eimicke, J. P, IDEATel Consortium, (2009). A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus: 5 Year Results of the IDEATel Study. J Am Med Inform Assoc 16: 446-456 [Abstract] [Full text]  
  • van Biesen, W., Van Laecke, S., Vanholder, R. (2009). Treatment of type 2 diabetes in chronic kidney disease: meekly follow the herd or call to arms?. Nephrol Dial Transplant 24: 2286-2287 [Full text]  
  • Shea, S., Weinstock, R. S., Teresi, J. A., Palmas, W., Starren, J., Cimino, J. J., Lai, A. M., Field, L., Morin, P. C., Goland, R., Izquierdo, R. E., Ebner, S., Silver, S., Petkova, E., Kong, J., Eimicke, J. P., IDEATel Consortium, (2009). A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus: 5 Year Results of the IDEATel Study. J. Am. Med. Inform. Assoc. 16: 446-456 [Abstract] [Full text]  
  • Wang, J., Imai, K., Engelgau, M. M., Geiss, L. S., Wen, C., Zhang, P. (2009). Secular Trends in Diabetes-Related Preventable Hospitalizations in the United States, 1998-2006. Diabetes Care 32: 1213-1217 [Abstract] [Full text]  
  • Greenstein, A. S., Price, A., Sonoyama, K., Paisley, A., Khavandi, K., Withers, S., Shaw, L., Paniagua, O., Malik, R. A., Heagerty, A. M. (2009). Eutrophic Remodeling of Small Arteries in Type 1 Diabetes Mellitus Is Enabled by Metabolic Control: A 10-Year Follow-Up Study. Hypertension 54: 134-141 [Abstract] [Full text]  
  • Cruickshank, J. M. (2009). Beta-blockers and hypertension.. J Am Coll Cardiol 53: 2105-2106 [Full text]  
  • Silva, K. C., Rosales, M. A.B., Biswas, S. K., Lopes de Faria, J. B., Lopes de Faria, J. M. (2009). Diabetic Retinal Neurodegeneration Is Associated With Mitochondrial Oxidative Stress and Is Improved by an Angiotensin Receptor Blocker in a Model Combining Hypertension and Diabetes. Diabetes 58: 1382-1390 [Abstract] [Full text]  
  • Doucette, W. R, Witry, M. J, Farris, K. B, McDonough, R. P (2009). Community Pharmacist-Provided Extended Diabetes Care. The Annals of Pharmacotherapy 43: 882-889 [Abstract] [Full text]  
  • Whitmer, R. A., Karter, A. J., Yaffe, K., Quesenberry, C. P. Jr, Selby, J. V. (2009). Hypoglycemic Episodes and Risk of Dementia in Older Patients With Type 2 Diabetes Mellitus. JAMA 301: 1565-1572 [Abstract] [Full text]  
  • Hunt, S. A., Abraham, W. T., Chin, M. H., Feldman, A. M., Francis, G. S., Ganiats, T. G., Jessup, M., Konstam, M. A., Mancini, D. M., Michl, K., Oates, J. A., Rahko, P. S., Silver, M. A., Stevenson, L. W., Yancy, C. W. (2009). 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol 53: e1-e90 [Full text]  
  • 2005 WRITING COMMITTEE MEMBERS, , Hunt, S. A., Abraham, W. T., Chin, M. H., Feldman, A. M., Francis, G. S., Ganiats, T. G., Jessup, M., Konstam, M. A., Mancini, D. M., Michl, K., Oates, J. A., Rahko, P. S., Silver, M. A., Stevenson, L. W., Yancy, C. W. (2009). 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation. Circulation 119: e391-e479 [Full text]  
  • Oster, R. T., Virani, S., Strong, D., Shade, S., Toth, E. L. (2009). Diabetes care and health status of First Nations individuals with type 2 diabetes in Alberta. cfp 55: 386-393 [Abstract] [Full text]  
  • Julien, E., Senecal, C., Guay, F. (2009). Longitudinal Relations among Perceived Autonomy Support from Health Care Practitioners, Motivation, Coping Strategies and Dietary Compliance in a Sample of Adults with Type 2 Diabetes. J Health Psychol 14: 457-470 [Abstract]  
  • Diabetes Prevention Program Research Group, (2009). Changes in Albumin Excretion in the Diabetes Prevention Program. Diabetes Care 32: 720-725 [Abstract] [Full text]  
  • de Galan, B. E., Perkovic, V., Ninomiya, T., Pillai, A., Patel, A., Cass, A., Neal, B., Poulter, N., Harrap, S., Mogensen, C.-E., Cooper, M., Marre, M., Williams, B., Hamet, P., Mancia, G., Woodward, M., Glasziou, P., Grobbee, D. E., MacMahon, S., Chalmers, J., on behalf of the ADVANCE Collaborative Group, (2009). Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes. J. Am. Soc. Nephrol. 20: 883-892 [Abstract] [Full text]  
  • Kooy, A., de Jager, J., Lehert, P., Bets, D., Wulffele, M. G., Donker, A. J. M., Stehouwer, C. D. A. (2009). Long-term Effects of Metformin on Metabolism and Microvascular and Macrovascular Disease in Patients With Type 2 Diabetes Mellitus. Arch Intern Med 169: 616-625 [Abstract] [Full text]  
  • Mancia, G. (2009). Prevention of risk factors: beta-blockade and hypertension. Eur Heart J Suppl 11: A3-A8 [Abstract] [Full text]  
  • Liew, G., Mitchell, P., Wong, T. Y (2009). Systemic management of diabetic retinopathy. BMJ 338: b441-b441 [Full text]  
  • O'Sullivan, E. P, Dinneen, S. F (2009). Benefits of early intensive glucose control to prevent diabetes complications were sustained for up to 10 years. Evid. Based Med. 14: 9-10 [Full text]  
  • Khavandi, K., Greenstein, A. S., Sonoyama, K., Withers, S., Price, A., Malik, R. A., Heagerty, A. M. (2009). Myogenic tone and small artery remodelling: insight into diabetic nephropathy. Nephrol Dial Transplant 24: 361-369 [Full text]  
  • Havas, S. (2009). The ACCORD Trial and Control of Blood Glucose Level in Type 2 Diabetes Mellitus: Time to Challenge Conventional Wisdom. Arch Intern Med 169: 150-154 [Full text]  
  • Duckworth, W., Abraira, C., Moritz, T., Reda, D., Emanuele, N., Reaven, P. D., Zieve, F. J., Marks, J., Davis, S. N., Hayward, R., Warren, S. R., Goldman, S., McCarren, M., Vitek, M. E., Henderson, W. G., Huang, G. D., the VADT Investigators, (2009). Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes. NEJM 360: 129-139 [Abstract] [Full text]  
  • Bhattacharyya, O. K., Estey, E. A., Cheng, A. Y.Y. (2009). Update on the Canadian Diabetes Association 2008 clinical practice guidelines. cfp 55: 39-43 [Full text]  
  • McGill, J. B. (2009). Reexamining Misconceptions About {beta}-Blockers in Patients With Diabetes. Clin. Diabetes 27: 36-46 [Abstract] [Full text]  
  • Lawler, F. H. (2009). Reasons to Exercise Caution When Considering a Screening Program for Type 2 Diabetes Mellitus. Mayo Clin Proc. 84: 34-36 [Full text]  
  • Ribaldo, P. D. B., Souza, D. S., Biswas, S. K., Block, K., Lopes de Faria, J. M., Lopes de Faria, J. B. (2009). Green tea (Camellia sinensis) Attenuates Nephropathy by Downregulating Nox4 NADPH Oxidase in Diabetic Spontaneously Hypertensive Rats. J. Nutr. 139: 96-100 [Abstract] [Full text]  
  • American Diabetes Association, (2009). Standards of Medical Care in Diabetes--2009. Diabetes Care 32: S13-S61 [Full text]  
  • Kjeldsen, S. E., Aksnes, T. A., Fagard, R. H., Mancia, G. (2009). CHAPTER 13 Hypertension. ESC Textbook of Cardiovascular Medicine 2: med-9780199566990-chapter-med-9780199566990-chapter [Abstract] [Full text]  
  • Kramer, C. K., Leitao, C. B., Canani, L. H., Gross, J. L. (2008). Impact of White-Coat Hypertension on Microvascular Complications in Type 2 Diabetes. Diabetes Care 31: 2233-2237 [Abstract] [Full text]  
  • Peterson, K. A., Radosevich, D. M., O'Connor, P. J., Nyman, J. A., Prineas, R. J., Smith, S. A., Arneson, T. J., Corbett, V. A., Weinhandl, J. C., Lange, C. J., Hannan, P. J. (2008). Improving Diabetes Care in Practice: Findings from the TRANSLATE trial. Diabetes Care 31: 2238-2243 [Abstract] [Full text]  
  • Rautio, A., Eliasson, M., Stegmayr, B. (2008). Favorable Trends in the Incidence and Outcome in Stroke in Nondiabetic and Diabetic Subjects: Findings From the Northern Sweden MONICA Stroke Registry in 1985 to 2003. Stroke 39: 3137-3144 [Abstract] [Full text]  
  • McLean, D. L., McAlister, F. A., Johnson, J. A., King, K. M., Makowsky, M. J., Jones, C. A., Tsuyuki, R. T., for the SCRIP-HTN Investigators, (2008). A Randomized Trial of the Effect of Community Pharmacist and Nurse Care on Improving Blood Pressure Management in Patients With Diabetes Mellitus: Study of Cardiovascular Risk Intervention by Pharmacists-Hypertension (SCRIP-HTN). Arch Intern Med 168: 2355-2361 [Abstract] [Full text]  
  • Mugarza, J. A, Wilding, J. P, Woodward, A., Hayden, K., Gill, G. V (2008). Achieving blood pressure control in patients with type 2 diabetes and diabetic renal disease by a nurse-led protocol based clinic. British Journal of Diabetes & Vascular Disease 8: 279-284 [Abstract]  
  • Koopman, R. J., Mainous, A. G. III, Everett, C. J., Carter, R. E. (2008). Tool to Assess Likelihood of Fasting Glucose ImpairmenT (TAG-IT). Ann Fam Med 6: 555-561 [Abstract] [Full text]  
  • Turnbull, F., Woodward, M., Neal, B., Barzi, F., Ninomiya, T., Chalmers, J., Perkovic, V., Li, N., MacMahon, S., the Blood Pressure Lowering Treatment Trialists' C, (2008). Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials. Eur Heart J 29: 2669-2680 [Abstract] [Full text]  
  • O'Rahilly, S., Weir, G. C., Matthews, D. R. (2008). An Appreciation of Robert Turner. Diabetes 57: 2918-2921 [Full text]  
  • Sloan, F. A., Belsky, D., Ruiz, D. Jr, Lee, P. (2008). Changes in Incidence of Diabetes Mellitus-Related Eye Disease Among US Elderly Persons, 1994-2005. Arch Ophthalmol 126: 1548-1553 [Abstract] [Full text]  
  • Young, M. J., McCardle, J. E., Randall, L. E., Barclay, J. I. (2008). Improved Survival of Diabetic Foot Ulcer Patients 1995-2008: Possible impact of aggressive cardiovascular risk management. Diabetes Care 31: 2143-2147 [Abstract] [Full text]  
  • Deshpande, A. D, Harris-Hayes, M., Schootman, M. (2008). Epidemiology of Diabetes and Diabetes-Related Complications. ptjournal 88: 1254-1264 [Abstract] [Full text]  
  • Kloner, R. A, Neutel, J., Roth, E. M, Weiss, R., Weinberger, M. H, Thakker, K. M, Schwartz, B., Shi, H., Gregg, A.-M., the ADHT Investigators, (2008). Blood Pressure Control with Amlodipine Add-on Therapy in Patients with Hypertension and Diabetes: Results of the Amlodipine Diabetic Hypertension Efficacy Response Evaluation Trial. The Annals of Pharmacotherapy 42: 1552-1562 [Abstract] [Full text]  
  • Bhattacharyya, O. K. MD PhD, Shah, B. R. MD PhD, Booth, G. L. MD MSc (2008). Management of cardiovascular disease in patients with diabetes: the 2008 Canadian Diabetes Association guidelines. CMAJ 179: 920-926 [Full text]  
  • Chalmers, J., Cooper, M. E. (2008). UKPDS and the Legacy Effect. NEJM 359: 1618-1620 [Full text]  
  • Holman, R. R., Paul, S. K., Bethel, M. A., Neil, H. A. W., Matthews, D. R. (2008). Long-Term Follow-up after Tight Control of Blood Pressure in Type 2 Diabetes. NEJM 359: 1565-1576 [Abstract] [Full text]  
  • Holman, R. R., Paul, S. K., Bethel, M. A., Matthews, D. R., Neil, H. A. W. (2008). 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes. NEJM 359: 1577-1589 [Abstract] [Full text]  
  • Martirosyan, L, Braspenning, J, Denig, P, de Grauw, W J C, Bouma, M, Storms, F, Haaijer-Ruskamp, F M (2008). Prescribing quality indicators of type 2 diabetes mellitus ambulatory care. Qual Saf Health Care 17: 318-323 [Abstract] [Full text]  
  • Zhang, X., Gregg, E. W., Cheng, Y. J., Thompson, T. J., Geiss, L. S., Duenas, M. R., Saaddine, J. B. (2008). Diabetes Mellitus and Visual Impairment: National Health and Nutrition Examination Survey, 1999-2004. Arch Ophthalmol 126: 1421-1427 [Abstract] [Full text]  
  • Feldstein, A. C., Nichols, G. A., Smith, D. H., Stevens, V. J., Bachman, K., Rosales, A. G., Perrin, N. (2008). Weight Change in Diabetes and Glycemic and Blood Pressure Control. Diabetes Care 31: 1960-1965 [Abstract] [Full text]  
  • Fowler, M. B. (2008). Hypertension, Heart Failure, and Beta-Adrenergic Blocking Drugs. J Am Coll Cardiol 52: 1073-1075 [Full text]  
  • Kern, T. S., Barber, A. J. (2008). Retinal ganglion cells in diabetes. J. Physiol. 586: 4401-4408 [Abstract] [Full text]  
  • Grant, R. W., Wald, J. S., Schnipper, J. L., Gandhi, T. K., Poon, E. G., Orav, E. J., Williams, D. H., Volk, L. A., Middleton, B. (2008). Practice-Linked Online Personal Health Records for Type 2 Diabetes Mellitus: A Randomized Controlled Trial. Arch Intern Med 168: 1776-1782 [Abstract] [Full text]  
  • Patasi, B., Conway, J. R. (2008). Enhancing diabetes care in family practice: A flow sheet. cfp 54: 1237-1238 [Full text]  
  • Saleem, T., Mohammad, K. H., Abdel-Fattah, M. M, Abbasi, A. H. (2008). Association of glycosylated haemoglobin level and diabetes mellitus duration with the severity of coronary artery disease. Diabetes and Vascular Disease Research 5: 184-189 [Abstract]  
  • Nikkanen, T., Timonen, M., Ylitalo, K., Timonen, O., Keinanen-Kiukaanniemi, S., Rajala, U. (2008). Quality of diabetes care among patients managed by teleconsultation. J Telemed Telecare 14: 295-299 [Abstract] [Full text]  
  • Poulter, N. R. (2008). Selecting a fixed combination to improve morbidity/mortality: the weight of evidence with ASCOT. Eur Heart J Suppl 10: G21-G28 [Abstract] [Full text]  
  • Dale, A. C., Vatten, L. J, Nilsen, T. I., Midthjell, K., Wiseth, R. (2008). Secular decline in mortality from coronary heart disease in adults with diabetes mellitus: cohort study. BMJ 337: a236-a236 [Abstract] [Full text]  
  • Romero, J. R., Morris, J., Pikula, A. (2008). Review: Stroke prevention: modifying risk factors. Ther Adv Cardiovasc Dis 2: 287-303 [Abstract]  
  • Hietala, K., Forsblom, C., Summanen, P., Groop, P.-H., on behalf of the FinnDiane Study Group, (2008). Heritability of Proliferative Diabetic Retinopathy. Diabetes 57: 2176-2180 [Abstract] [Full text]  
  • Agwu, J C. (2008). Screening for type 2 diabetes mellitus in children and adolescents. British Journal of Diabetes & Vascular Disease 8: 163-168 [Abstract]  
  • Pearce, K. A., Love, M. M., Shelton, B. J., Schoenberg, N. E., Williamson, M. A., Barron, M. A., Houlihan, J. M. (2008). Cardiovascular Risk Education and Social Support (CaRESS): Report of a Randomized Controlled Trial from the Kentucky Ambulatory Network (KAN). J Am Board Fam Med 21: 269-281 [Abstract] [Full text]  
  • Dokken, B. B. (2008). The Parodox of Glycemic Control and Cardiovascular Complications: Sorting Out the Data. Diabetes Spectr. 21: 150-152 [Full text]  
  • U.S. Preventive Services Task Force, (2008). Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement. ANN INTERN MED 148: 846-854 [Abstract] [Full text]  

Rapid Responses:

Read all Rapid Responses

diet & exercise control of diabetes
Michael Coulson
bmj.com, 25 Sep 1998 [Full text]
UKPDS -a model in ethics and diabetes public health
K M Venkat Narayan
bmj.com, 25 Sep 1998 [Full text]
Publishing important findings in two journals
Jonathan Richards
bmj.com, 30 Sep 1998 [Full text]
Query regarding numbers needed to treat
Stefan M Groetsch
bmj.com, 15 Oct 1998 [Full text]
Deficiencies of UKPDS
Paul Neeskens
bmj.com, 18 Nov 1998 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ