UKPDS trial

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

The Diabetes Control and Complications Trial (DCCT), the Stockholm Diabetes Intervention Study (DIS), the United Kingdom Prospective Diabetes Study (UKPDS), and the Japanese Kumamoto study show unequivocally that vigorous treatment of diabetes can decrease both the morbidity and mortality of the disease by reducing chronic complications. 

Intensive pharmacologic treatment of diabetes is known to decrease the risk for microvascular events such as nephropathy and retinopathy, but there is less evidence that it decreases macrovascular disease (28,29). DCCT/EDIC trial, however, demonstrated reduction in CVD (nonfatal Ml, stroke, death from CVD, confirmed angina, or the need for coronary-artery revascularization) in patients with type I diabetes assigned to intensive diabetes treatment compared with conventional treatment by 42% (p = 0.02) (30). Patients with lower extremity PAD and both type I and type 2 diabetes should be treated to reduce their glycosylated hemoglobin (Hb AIC) to less than 7%, per the American Diabetes Association recommendation (31). Subanalysis of the UKPDS showed no evidence of a threshold effect of Hb AIC a I % reduction in Hb Al C was associated with a 35% reduction in microvascular endpoints, an 18% reduction in Ml, and a 17% reduction in all-cause mortality. Frequent foot inspection by patients and physicians will enable early identification of foot lesions and ulcerations and facilitate prompt referral for treatment (32). 

Intensive glycemic control is paramount for reduction of microvascular complications (neuropathy, retinopathy, and nephropathy) as evidenced by the Diabetes Control and Complications Trial in type 1 DM and the United Kingdom Prospective Diabetes Study (UKPDS) in type 2 DM. The UKPDS also reported that control of hypertension in patients with diabetes will not only reduce the risk of retinopathy and nephropathy, but also reduce cardiovascular risk. 

Gray A. Raikou M, McGuire A, et al. Cost effectiveness of an intensive blood glucose control policy in patient with type 2 diabetes Economic analysis alongside randomized controlled trial (UKPDS 41). BMJ 2000 320 1373-1378. 

On the other hand, in large clinical trials like the UKPDS or the recently published ADOPT-study... 

The risk of major events was reported between 0.6% and 2% in the ADOPT-study and the UKPDS [11], being markedly lower than in intensively treated type 1 diabetic patients in the Diabetes Control and Complications Trial (DCCT)... 

Thns, Siperstein was a challenge to the architects of the DCCT (Diabetes Control and Complication Trial) and the UKPDS (The United Kingdom Prospective Diabetes Stndy) stndy, which later firmly docnmented that glycemic control was important althongh also blood pressnre was a clear factor involved at least in type 2 diabetes and certainly also according to other stndies in type 1 diabetes, especially regarding renal function. Gerich... 

UKPDS Gronp. UK Prospective Diabetes Study 17 A nine-year update of a randomized, controlled trial on the effect of improved metabolic control on complications in non-insnUn-dependent diabetes melUtus. Ann. Intern. Med. 1996 124 136 45. 

---