The UKPDS (UK Prospective Diabetes Study), an influential work in the United Kingdom on 4,000 type 2 diabetics 1977 onwards, was designed to determine whether or not tight control of blood sugar (g lycaemic control) in diabetes decreased diabetes-related complications and reduced mortality. The results of this, first reported in 1998, suggested that though good blood sugar control reduced the risk of eye, kidney and nerve-related complications, it did not reduce the risk of heart attacks, strokes and death significantly.
However, late 2008, results from a follow-up study of the original participants in the UKPDS, indicated a ‘legacy effect’ of the original intervention. Despite no longer being subjected to the same rigorous intervention, patients who had initially been subjected to tight glycaemic control continued to show benefits in various diabetes related outcomes, including heart attacks, strokes and mortality. This suggests that there is possibly some ‘metabolic memory’ that allows previous good glucose control to continue to manifest its legacy, in terms of prevention of diabetes related complications.
So what does all this means? The Diabetes UK study shows that good blood sugar level control should be the aim from the time diabetes is first diagnosed with appropriate increase in the dose of medication or addition of therapies sequentially rather than letting the glycaemic control drift to unacceptable levels and then applying heroic rescue therapy.
