Frighi

Abstract: ONE OF THE MAIN GOALS OF treating patients with type 2 diabetes mellitus is to produce near-normal glucose levels to prevent the development of diabetic complications. The Diabetes Control and Complications Trial and Stockholm studies in white patients with type 1 diabetes mellitus, and the Kumamoto study in nonobese Japanese patients with type 2 diabetes and the UK Prospective Diabetes Study (UKPDS) indicate that improved blood glucose control will delay the progress of microvascular complications. An epidemiological study of Pima Indians suggested that when the fasting plasma glucose (FPG) level is less than 7.8 mmol/L (140 mg/dL), the risk of developing microvascular complications is lower. This finding was corroborated by a similar study in whites with 2-hour oral FPG tolerance data. More recent studies have shown the risk of retinopathy to increase at FPG levels between 6.4 and 7.6 mmol/L (115-137 mg/dL) in Pima Indians, between 6.0 and 7.2 mmol/L (108-130 mg/dL) in Egyptians, and between 6.0 and 6.7 mmol/L (108-121 mg/dL) in a US population sample. The level of glycosylated hemoglobin A1c (HbA1c) that is equivalent to this level of hyperglyAuthor Affiliations: Radcliffe Infirmary, Oxford, England. A complete list of the members of the UK Prospective Diabetes Study Group was published previously (Lancet. 1998;352:837-853). Financial Disclosure: We received support from pharmaceutical companies including Novo Nordisk Pharmaceuticals A/S (Bagsvaerd, Denmark), Bayer Pharmaceutical Division (Newbury, England), Bristol Myers Squibb Co (Hounslow, England), Hoechst Marion Roussel (Bridgewater, NJ), Eli Lilly & Co (Indianapolis, Ind), Lipha (Lyon, France), and Farmitalia Carlo Erba (St Albans, England). Additional assistance was provided by Boehringer Mannheim Corp (Livingston, Scotland), Becton Dickinson Co (Oxford, England), Owen Mumford (Woodstock, England), Securicor (London, England), Eastman Kodak Co Health Imaging Division (Hemel Hempstead, England), and Cortecs Diagnostics (Deeside, Scotland). CorrespondingAuthorandReprints: RobertC.Turner, FRCP, UKPDS Study Group, Diabetes Research Laboratories, Radcliffe Infirmary, Woodstock Road, Oxford, EnglandOX26HE(e-mail: robert.turner@drl.ox.ac.uk). Context Treatment with diet alone, insulin, sulfonylurea, or metformin is known to improve glycemia in patients with type 2 diabetes mellitus, but which treatment most frequently attains target fasting plasma glucose (FPG) concentration of less than 7.8 mmol/L (140 mg/dL) or glycosylated hemoglobin A1c (HbA1c) below 7% is unknown. Objective To assess how often each therapy can achieve the glycemic control target levels set by the American Diabetes Association.