ICEECE2012 Symposia The risk and benefits of tight glycaemic control (3 abstracts)
During the 10-year UK Prospective Diabetes Study (UKPDS) post-trial monitoring period, sustained reductions were seen in the risks of diabetic complications, despite the previously randomised conventional and intensive treatment groups becoming identical with respect to median HbA1c values and glucose-lowering therapies. This continuing benefit of an earlier intervention in people with type 2 diabetes has been termed the legacy effect. A similar phenomenon seen in people with type 1 diabetes has been termed the metabolic memory. At the present time, neither the precise mechanism which produces the legacy effect nor the time course over which it operates have been established.
Analyses have been conducted to examine the degree to which the UKPDS glucose legacy effect can be attributed to prolonged benefits of HbA1c levels achieved in each of the previous years since diagnosis of diabetes. The impact of each annual HbA1c value on the future risk of death or myocardial infarction has been estimated, assuming the risk at every moment depended on the contributions from all previous moments.
Major effects of improved glycaemic control are seen 510 years later, explaining in part the sustained reductions in risk of death and myocardial infarction seen in the UKPDS post-trial monitoring period.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.