Description

The United Kingdom Prospective Diabetes Study (UKPDS) investigated the long-term benefits of intensive control of blood glucose and blood pressure in patients with type 2 diabetes. It demonstrated that after ten years of intensive glycaemic control, there were significant reductions in diabetes-related end points largely due to a 25% reduction in microvascular complications. It also demonstrated that intensive blood pressure control reduces the risk of diabetes-related death by 32% with a 44% reduction in strokes. In addition, intensive blood pressure control reduced microvascular end points by 37% and significant worsening of visual acuity which is largely due to maculopathy by 34%. The benefits of blood pressure control occurred over ten years, however they became apparent after as little as 4.5 years of follow—up. Hypoglycaemia was more common in patients allocated to intensive blood glucose control. In elderly patients, the risk of hypoglycaemia may outweigh the benefits of strict glucose control which may take up to ten years to be effective. Intensive blood pressure control, on the other hand, may provide early benefit in this age group.