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United Kingdom Prospective Diabetes Study (UKPDS). 13: Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years.
BMJ 1995; 310(6972):83-8BMJ

Abstract

OBJECTIVE

To assess the relative efficacy of treatments for non-insulin dependent diabetes over three years from diagnosis.

DESIGN

Multicentre, randomised, controlled trial allocating patients to treatment with diet alone or additional chlorpropamide, glibenclamide, insulin, or metformin (if obese) to achieve fasting plasma glucose concentrations < or = 6 mmol/l.

SETTING

Outpatient diabetic clinics in 15 British hospitals.

SUBJECTS

2520 subjects who, after a three month dietary run in period, had fasting plasma glucose concentrations of 6.1-14.9 mmol/l but no hyperglycaemic symptoms.

MAIN OUTCOME MEASURES

Fasting plasma glucose, glycated haemoglobin, and fasting plasma insulin concentrations; body weight; compliance; and hypoglycaemia.

RESULTS

Median fasting plasma glucose concentrations were significantly lower at three years in patients allocated to chlorpropamide, glibenclamide, or insulin rather than diet alone (7.0, 7.6, 7.4, and 9.0 mmol/l respectively; P < 0.001) with lower mean glycated haemoglobin values (6.8%, 6.9%, 7.0%, and 7.6%, respectively; P < 0.001). Mean body weight increased significantly with chlorpropamide, glibenclamide, and insulin but not diet (by 3.5, 4.8, 4.8, and 1.7 kg; P < 0.001). A similar pattern was seen for mean fasting plasma insulin concentration (by 0.9, 1.2, 2.4, and -0.1 mU/l; P < 0.001). In obese subjects metformin was as effective as the other drugs with no change in mean body weight and significant reduction in mean fasting plasma insulin concentration (-2.5 mU/l; P < 0.001). More hypoglycaemic episodes occurred with sulphonylurea or insulin than with diet or metformin.

CONCLUSION

The drugs had similar glucose lowering efficacy, although most patients remained hyperglycaemic. Long term follow up is required to determine the risk-benefit ratio of the glycaemic improvement, side effects, changes in body weight, and plasma insulin concentration.

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

7833731

Citation

"United Kingdom Prospective Diabetes Study (UKPDS). 13: Relative Efficacy of Randomly Allocated Diet, Sulphonylurea, Insulin, or Metformin in Patients With Newly Diagnosed Non-insulin Dependent Diabetes Followed for Three Years." BMJ (Clinical Research Ed.), vol. 310, no. 6972, 1995, pp. 83-8.
United Kingdom Prospective Diabetes Study (UKPDS). 13: Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years. BMJ. 1995;310(6972):83-8.
(1995). United Kingdom Prospective Diabetes Study (UKPDS). 13: Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years. BMJ (Clinical Research Ed.), 310(6972), pp. 83-8.
United Kingdom Prospective Diabetes Study (UKPDS). 13: Relative Efficacy of Randomly Allocated Diet, Sulphonylurea, Insulin, or Metformin in Patients With Newly Diagnosed Non-insulin Dependent Diabetes Followed for Three Years. BMJ. 1995 Jan 14;310(6972):83-8. PubMed PMID: 7833731.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - United Kingdom Prospective Diabetes Study (UKPDS). 13: Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years. PY - 1995/1/14/pubmed PY - 1995/1/14/medline PY - 1995/1/14/entrez SP - 83 EP - 8 JF - BMJ (Clinical research ed.) JO - BMJ VL - 310 IS - 6972 N2 - OBJECTIVE: To assess the relative efficacy of treatments for non-insulin dependent diabetes over three years from diagnosis. DESIGN: Multicentre, randomised, controlled trial allocating patients to treatment with diet alone or additional chlorpropamide, glibenclamide, insulin, or metformin (if obese) to achieve fasting plasma glucose concentrations < or = 6 mmol/l. SETTING: Outpatient diabetic clinics in 15 British hospitals. SUBJECTS: 2520 subjects who, after a three month dietary run in period, had fasting plasma glucose concentrations of 6.1-14.9 mmol/l but no hyperglycaemic symptoms. MAIN OUTCOME MEASURES: Fasting plasma glucose, glycated haemoglobin, and fasting plasma insulin concentrations; body weight; compliance; and hypoglycaemia. RESULTS: Median fasting plasma glucose concentrations were significantly lower at three years in patients allocated to chlorpropamide, glibenclamide, or insulin rather than diet alone (7.0, 7.6, 7.4, and 9.0 mmol/l respectively; P < 0.001) with lower mean glycated haemoglobin values (6.8%, 6.9%, 7.0%, and 7.6%, respectively; P < 0.001). Mean body weight increased significantly with chlorpropamide, glibenclamide, and insulin but not diet (by 3.5, 4.8, 4.8, and 1.7 kg; P < 0.001). A similar pattern was seen for mean fasting plasma insulin concentration (by 0.9, 1.2, 2.4, and -0.1 mU/l; P < 0.001). In obese subjects metformin was as effective as the other drugs with no change in mean body weight and significant reduction in mean fasting plasma insulin concentration (-2.5 mU/l; P < 0.001). More hypoglycaemic episodes occurred with sulphonylurea or insulin than with diet or metformin. CONCLUSION: The drugs had similar glucose lowering efficacy, although most patients remained hyperglycaemic. Long term follow up is required to determine the risk-benefit ratio of the glycaemic improvement, side effects, changes in body weight, and plasma insulin concentration. SN - 0959-8138 UR - https://www.unboundmedicine.com/medline/citation/7833731/United_Kingdom_Prospective_Diabetes_Study__UKPDS___13:_Relative_efficacy_of_randomly_allocated_diet_sulphonylurea_insulin_or_metformin_in_patients_with_newly_diagnosed_non_insulin_dependent_diabetes_followed_for_three_years_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&amp;pmid=7833731 DB - PRIME DP - Unbound Medicine ER -