(1) The UKPDS trial was a very large, complex, comparative study with methodological weaknesses such as the absence of blinding. It showed that lowering the
blood glucose level in patients with
type 2 diabetes reduces the risk of clinical complications, especially
diabetic microangiopathy. (2) In contrast, glycaemic control had no statistically significant impact on mortality. (3) Contrary to findings in a previous trial,
glucose-lowering sulphonylureas and
insulin did not increase cardiovascular morbidity or mortality in the UKPDS study. (4)
Glibenclamide was the only
drug tested that yielded a statistically significant reduction in the risk of clinical complications linked to
type 2 diabetes. (5) Strict glycaemic control with a
glucose-lowering sulphonylurea or
insulin was associated with hypoglycaemic episodes in approximately a quarter of patients each year. (6)
Metformin gave conflicting results that are difficult to explain:
metformin reduced mortality in
overweight patients with
type 2 diabetes; but in diabetic patients poorly controlled by
glucose-lowering sulphonylureas, mortality was higher in the group treated with the sulphonylurea +
metformin combination than in the group that continued treatment with a sulphonylurea alone. (7) Currently, the results of the UKPDS trial are the only available clinical data on which to base the choice of treatment for type 2 diabetic patients aged between 25 and 65 years. When a
glucose-lowering
drug is considered necessary and is not contraindicated, the first-line choice is
glibenclamide for diabetics who are not
overweight, and
metformin for those who are.