LESSONS FROM UK PROSPECTIVE DIABETES STUDY

Type II diabetes is a major cause of morbidity and mortality, both fro m an increased risk of developing cardiovascular disease and from spec ific diabetic complications. At present, patients are often treated to prevent marked hyperglycaemia, that induces symptoms such as thirst. Moderately raised glucose levels are then accepted. At present, it is uncertain whether Type II diabetes should be treated more intensively, with diet, tablet or insulin therapy to maintain near-normal glucose levels, in order to prevent the onset of complications. The Diabetes C ontrol and Complications Trial (DCCT) in insulin-dependent diabetic su bjects with a mean age of 27 years has indicated that intensive therap y to achieve a haemoglobin Ale level of 7.1%, compared with 9.0% in a 'standard control group', will retard the progress of diabetic microva scular disease. It is not known whether this is similarly beneficial i n Type II diabetic subjects, where the main complication is cardiac di sease, or whether the even better control that can be obtained with ph armaceutical therapy in Type II diabetic patients would be worthwhile. It is similarly not known whether treatment with sulphonylurea, metfo rmin or insulin is particularly beneficial or whether any of these the rapies is potentially harmful. The UK Prospective Diabetes Study (UKPD S) has randomly allocated 4209 newly diagnosed Type II diabetic patien ts to different therapies and is determining: (a) whether improved glu cose control will delay the onset of clinical complications; and (b) w hether any specific therapy has advantages or disadvantages.