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 HbA1c 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 HbA1c 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 HbA1c is likely to reduce the risk of complications, with the lowest risk being in those with HbA1c 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]
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