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Negative consequences can occur early when patients have elevated glucose

Progressive damage may occur even prior to diagnosis

elevated glucose

  • In the UKPDS, patients whose glucose tolerance was most severely impaired at the time of diagnosis had already lost 80%-85% of their β–cell function2

Early and intensive intervention may improve current and future outcomes

  • 10-year follow-up from UKPDS identified a “legacy effect” associated with more intensive treatment3
    • Long-term outcomes were significantly better in patients initially randomized to pharmacologic interventions vs patients randomized to dietary restriction only
    • Significant risk reductions were observed for any-cause mortality, diabetes-related death, and any diabetes-related endpoint
Mortality in patients comparing sulfonylurea or insulin to dietary restriction alone upon T2DM diagnosis

Mortality in overweight patients comparing metformin to dietary restriction alone upon T2DM diagnosis


HOMA=homeostasis model assessment; T2DM=type 2 diabetes mellitus; UKPDS=United Kingdom Prospective Diabetes Study

Study Design: Randomized, open-label, multicenter study of 4209 UKPDS patients with T2DM from 23 hospital-based clinics in the United Kingdom. Patients were randomized either to dietary restriction or to treatment with either a sulfonylurea or an insulin-based regimen, or metformin for patients who were more than 120% of their ideal weight. During 10 years of follow-up, patients were returned to community- or hospital-based care, but were seen annually for the first 5 years, and by questionnaire during years 6-10.3

Guidelines by the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) recommend healthy eating, weight control, increased physical activity, and diabetes education as a foundation for T2DM management throughout the course of treatment.4,5



When you intensify treatment in your patients with T2DM, will your next move do enough?


1. Holman RR. Assessing the potential for alpha-glucosidase inhibitors in prediabetic states. Diabetes Res Clin Pract. 1998;40(Suppl):S21-S25. 2. DeFronzo RA. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58(4):773-795. 3. Holman RR, Paul SK, Bethel A, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577-1589. 4. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2016;39(Suppl 1):S1-S112. 5. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and the American College of Endocrinology on the comprehensive type 2 diabetes management algorithm—2016 executive summary. Endocr Pract. 2016;22(1):84-113.