BMJ 2000;321:405-412 ( 12 August )

Papers

Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study

Editorial by Tuomilehto

Irene M Stratton, senior statistician, ^a Amanda I Adler, epidemiologist, ^a H Andrew W Neil, university lecturer in clinical epidemiology, ^b David R Matthews, consultant diabetologist, ^c Susan E Manley, biochemist, ^a Carole A Cull, senior statistician, ^a David Hadden, consultant physician, ^d Robert C Turner, director, ^e Rury R Holman, director, ^a on behalf of the UK Prospective Diabetes Study Group.

^a Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE, ^b Division of Public Health and Primary Care, Institute of Health Sciences, University of Oxford, Oxford OX3 7LF, ^c Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Radcliffe Infirmary, ^d Royal Victoria Hospital, Belfast BT12 6BA, ^e Diabetes Research Laboratories, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Radcliffe Infirmary

Correspondence to: I M Stratton irene.stratton{at}dtu.ox.ac.uk

Objective: To determine the relation between exposure to glycaemia over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes.
Design: Prospective observational study.
Setting: 23 hospital based clinics in England, Scotland, and Northern Ireland.
Participants: 4585 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk.
Outcome measures: Primary predefined aggregate clinical outcomes: any end point or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, amputation (including death from peripheral vascular disease), and microvascular disease (predominantly retinal photo-coagulation). Single end points: non-fatal heart failure and cataract extraction. Risk reduction associated with a 1% reduction in updated mean HbA_1c adjusted for possible confounders at diagnosis of diabetes.
Results: The incidence of clinical complications was significantly associated with glycaemia. Each 1% reduction in updated mean HbA_1c was associated with reductions in risk of 21% for any end point related to diabetes (95% confidence interval 17% to 24%, P<0.0001), 21% for deaths related to diabetes (15% to 27%, P<0.0001), 14% for myocardial infarction (8% to 21%, P<0.0001), and 37% for microvascular complications (33% to 41%, P<0.0001). No threshold of risk was observed for any end point.
Conclusions: In patients with type 2 diabetes the risk of diabetic complications was strongly associated with previous hyperglycaemia. Any reduction in HbA_1c is likely to reduce the risk of complications, with the lowest risk being in those with HbA_1c values in the normal range (<6.0%).

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Rapid Responses:

Read all Rapid Responses

Association of glycaemia with complications of type 2 diabetes: Is glycaemic treatment important?

Brian Budenholzer
bmj.com, 12 Aug 2000 [Full text]

Methodological problems

Adrian Bagust
bmj.com, 12 Oct 2000 [Full text]

Removing the influence of LADA patients will add more value to UKPDS35 findings on Type 2 diabetes related complications.

Arya K Kumarasena
bmj.com, 15 Dec 2007 [Full text]