Metformin and the united kingdom prospective diabetes study: a commentary

Abstract

Victoria Hospital, Kirkcaldy, andDepartment of Biological andMedical Sciences, University ofSt Andrews, Fife, ScotlandRecebido em 29/02/2000Aceito em 17/03/2000INTRODUCTION TO UKPDSThe United Kingdom Prospective Diabetes Study (UKPDS) was the largestand longest trial ever conducted into diabetes mellitus. This landmark studywas set up in 1977, recruited 5,012 patients with type 2 diabetes mellitus(DM) from 23 centres in the UK, and finished at the end of 1997, with theinitial final results published in two papers in the Lancet and in a furtherthree papers in the British Medical Journal in September 1998 (1-5), at thesame time as the results were first presented publically at the European Asso-ciation for the Study of Diabetes (EASD) meeting in Barcelona.The study was co-ordinated by the late Professor Robert Turner andhis colleagues in Oxford, UK.The UKPDS asked two principle questions:1. Can the risk of complications in type 2 DM be reduced by intensiveblood glucose control?2. In type 2 DM subjects with hypertension, can the risk of complica-tions be reduced by tight blood pressure control?The two principal positive conclusions from the UKPDS were:1. Intensive blood glucose reduction is worthwhile.2. Tight blood pressure control will show clear benefits.These results have been widely publised and reviewed in the scien-tific literature (6-9), with regard to stressing the importance of both gly-caemic and blood pressure control in type 2 DM. The UKPDS is the abid-ing legacy of Robert Turner (10).In the UKPDS, intensive blood glucose control with sulphonylureasor insulin, compared with conventional treatment (diet alone), with a 11%difference in glycated haemoglobin maintained over 10 years (mean 7.0%compared to 7.9%) showed a 25% reduction in microvascular complicationsbut no significant benefit was seen in macrovascular complications (1).However, in the overweight patients where metformin was an addi-tional option in therapy to sulphonylureas or insulin, there were definite andsignificant benefits in macrovascular end points observed. This short reviewwill highlight these positive outcomes seen with metformin therapy.