United Kingdom prospective diabetes study

Abstract

At present, therapy of the 2 diabetes does not prevent complications such as cardiovascular disease or retinopathy. Diabetes control is often assessed by glycosuria measurements, but patients without glycosuria often have high blood glucose concentrations. Patients with type 2 diabetes have fairly constant raised-overnight, basal plasma glucose concentrations, which are repeatable from night to night. A logical aim of therapy is for a normal fasting plasma glucose concentration, which can often be obtained either with sulphonylurea therapy or with a constant basal insulin supplement provided by ultralente insulin. The fasting plasma glucose (fpg) concentration provides an easy to understand single criterion of control, and it is clinically feasible to aim for fpg <6 mmol/L. While in theory improved control of diabetes should prevent complications, it is uncertain (1) whether this would diminish the morbidity and mortality of the disease, and (2) whether it is preferable to lower the blood glucose concentration with insulin or oral hypoglycemic agents. The University Group Diabetes Program (UGDP) suggested that tolbutamide and phenformin may be more harmful than beneficial. This study has provoked considerable controversy and has had little effect on clinical practice. One possible reason for the lack of benefit of therapies in the UGDP might have been that the control achieved was inadequate. Thus, at the end of the study, the mean fasting blood glucose in the best group, treated by variable doses of insulin, was 6.7 mmol/L at the 35th visit, representing a fpg of 7.8 mmol/L.