What are the results of the Diabetes Control and Complications Trial (DCCT) and UK Prospective Diabetes Study (UKPDS)?
The DCCT found that intensive glycemic control reduced the risk of cardiovascular events by 42%. However, intensive glycemic control only reduced microvascular complications (primarily the need for retinal laser photocoagulation) in the UKPDS patients with type 2 diabetes mellitus, and there was no significant improvement in any endpoint associated with treatment with a sulfonylurea. Patients in the UKPDS treated with metformin had a lower median HbA1c (7.4% versus 8.0%) and a 37% reduction in $1 diabetes endpoints compared with those in the conventional therapy (diet alone) group. The PROactive (Prospective Pioglitazone Clinical Trial in Macrovascular Events) study found that patients with type 2 diabetes mellitus and evidence of vascular disease who were randomized to pioglitazone had an average HbA1c of 7.8%, which decreased by 0.8% in those on active therapy.