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UKPDS

UKPDS. UKPDS Legacy Effect. Background United Kingdom Prospective Diabetes Study (UKPDS) 10-year follow-up Mean HbA 1c levels identical in groups previously randomized to intensive or conventional glucose control

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UKPDS

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  1. UKPDS UKPDS Legacy Effect • Background • United Kingdom Prospective Diabetes Study (UKPDS) 10-year follow-up • Mean HbA1c levels identical in groups previously randomized to intensive or conventional glucose control • Intensive vs conventional control group remained at significantly lower risk of complications • All-cause mortality: HR=0.87; p=0.006 • MI: HR=0.85; p=0.014 • This continuing benefit has been termed T2DM legacy effect

  2. UKPDS Objectives • Determine the degree to which historic HbA1c values contribute to later reduced risk of MI and all-cause mortalityDetermine time-dependent impact of earlier HbA1c values on year-to-year basis Methods • 3849 UKPDS patients examined • Analyses restricted to period for which HbA1c measurements available • Continuous hazard functions estimated over 0-20 years for death and MI in relation to HbA1c, age, sex, and treatment group

  3. UKPDS • Results • HbA1c, older age, and male sex, but not treatment group, significantly associated with MI and death (p<0.001 for all) • Reduction in risk of all-cause mortality almost 3X stronger with early HbA11c reduction (based on modeled impact of 1% HbA1c reduction on death) • Early HbA1c reduction also reduced risk of MI (based on modeled impact of 1% HbA1c reduction on MI)

  4. UKPDS • Conclusions • Despite absence of glycemic difference during 10-year post-UKPDS observational follow-up, there was continued reduction in risk of complications with emergent risk reductions for MI and death • Statistical modeling confirmed that earlier HbA1c levels continue to contribute to risk of diabetic complications, as seen in the Diabetes Control and Complications Trial (DCCT) [N Engl J Med 1993] • Waiting years after diagnosis of T2DM to minimize glycemia is unlikely to achieve full benefits of immediate intervention • Achieving and maintaining optimal glycemic control is essential to minimize long-term risk of diabetic complications

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