Management of type 2 diabetes: long-awaited evidence of benefits after blood sugar control.
(1) The UKPDS trial was a very large, complex, comparative study with methodological weaknesses such as the absence of blinding. It showed that lowering the blood glucose level in patients with type 2 diabetes reduces the risk of clinical complications, especially diabetic microangiopathy. (2) In contrast, glycaemic control had no statistically significant impact on mortality. (3) Contrary to findings in a previous trial, glucose-lowering sulphonylureas and insulin did not increase cardiovascular morbidity or mortality in the UKPDS study.  (4) Glibenclamide was the only drug tested that yielded a statistically significant reduction in the risk of clinical complications linked to type 2 diabetes.  (5) Strict glycaemic control with a glucose-lowering sulphonylurea or insulin was associated with hypoglycaemic episodes in approximately a quarter of patients each year. (6) Metformin gave conflicting results that are difficult to explain: metformin reduced mortality in overweight patients with type 2 diabetes; but in diabetic patients poorly controlled by glucose-lowering sulphonylureas, mortality was higher in the group treated with the sulphonylurea + metformin combination than in the group that continued treatment with a sulphonylurea alone.  (7) Currently, the results of the UKPDS trial are the only available clinical data on which to base the choice of treatment for type 2 diabetic patients aged between 25 and 65 years.  When a glucose-lowering drug is considered necessary and is not contraindicated, the first-line choice is glibenclamide for diabetics who are not overweight, and metformin for those who are.
D002318:Cardiovascular Diseases / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D005905:Glyburide / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008687:Metformin / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome; D006113:United Kingdom
D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D005905:Glyburide