Impact of the UKPDS--an overview.

The UK Prospective Diabetes Study (UKPDS) is a group of clinical trials, epidemiological analyses and health-modelling studies with an influence which can be assessed across a broad range of health domains. Original publications (n = 85) are notable for being mainly published in the key weekly or diabetes journals (78%) and being mainly in the clinical arena (68%). Notable reference to the publications can be found in UK National Institute for Clinical Excellence (NICE) guidelines, but also in evidence-based international guidelines, where UKPDS papers form a significant fraction of the citations. In educational materials UKPDS-derived slides remain popular (10 and 30% of some international slide sets), again as much for the epidemiological findings as for the core trial results. Slides of the deterioration in blood glucose control with time, and evidence that this is as a result of progressive decline of pancreatic islet B-cell function, are used particularly often. The UKPDS enhanced the promotion of glycated haemoglobin to its core role in clinical monitoring, through understanding of the quantitative relationship of vascular complications to glucose control, and thus to target setting. Notably, metformin therapy was promoted by the UKPDS findings on macrovascular disease in the overweight study, although controversy remains regarding the significance of the effect on macrovascular disease of the core glucose-lowering study, promoting the development of further studies reporting in 2008. The effects of decreasing blood pressure on microvascular disease have had an important impact on guidelines and health economic analyses, together with other evidence on the value of rennin-angiotensin system blockers. The UKPDS has evidently been unusually influential in the development of treatment guidelines, clinical education and the thinking of healthcare professionals. By inference it must be responsible for a significant part of the improvement in health outcomes in people with Type 2 diabetes over the last decade.