Im. Stratton et al., Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study, BR MED J, 321(7258), 2000, pp. 405-412
Citations number
47
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Objective To determine the relation between exposure to glycaemia over time
and the risk of macro vascular or microvascular complications in patients
with type 2 diabetes.
Design Prospective observational study.
Setting 23 hospital based clinics in England, Scotland, and Northern irelan
d.
Participants 4585 white, Asian Indian, and Afro-Caribbean UKPDS patients, w
hether randomised or not to treatment, were included in analyses of inciden
ce; of these, 3642 were included in analyses of relative risk.
Outcome measures Primary predefined aggregate clinical outcomes: any end po
int or deaths related to diabetes and all cause mortality. Secondary aggreg
ate outcomes: myocardial infarction, stroke, amputation (including death fr
om peripheral vascular disease), and microvascular disease (predominantly r
etinal photocoagulation). Single end points: non-fatal heart failure and ca
taract 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 associate
d 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% c
onfidence interval 17% to 24%, P < 0.0001), 21% for deaths related to diabe
tes (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 Ln patients with type 2 diabetes the risk of diabetic complicat
ions was strongly associated with previous hyperglycaemia. Any reduction in
HbA(1c) is likely to reduce the risk of complications, with the lowest ris
k being in those with HbA(1c) values in the normal range (< 6.0%).