A review of the United Kingdom Prospective Diabetes Study (UKPDS) and a discussion of the implications for patient care.

Introduction Diabetes Mellitus is a chronic illness that increases the risk of microvascular complication and results in blindness, kidney failure, and lower extremity amputations, and macrovascular complication of coronary artery disease and stroke. In the State of Hawaii, an estimated eight to ten percent of the population have diabetes mellitus, i.e. about 80,000 to 100,000 individuals, primarily adults with type 2 diabetes. Alarmingly, native Hawaiian adults over 30 years of age have been identified with a diabetes prevalence rate of 20%. Several studies clearly document the increasing rate of diabe tes among native Hawaiians over the past 30 years. Based on recent data, it is estimated that about 20,000 adult native Hawaiians (1820% prevalence rate) have diabetes mellitus) It would appear that interventions to prevent diabetes and diabetic complications receive the highest priority in the effort to improve the health status of the people of Hawaii, especially native Hawaiians. Two major intervention trials have clearly demonstrated that intensive glycemic control prevents and delays the development of microvascular complication in patients with type 1 diabetes: the Diabetes Control and Complications Trial (DCCT) and the Stockholm Diabetes Intervention Study (SDIS). 23 Results from a randomized prospective 6-year study in Japan show that intensive insulin treat ment of type 2 diabetic patients reduces microvascular complica tion. 4Many studies have demonstrated the association of hypergly cemia with macrovascular complications of ischemic heart disease and stroke and increased cardiovascular disease risk factors, e.g., dyslipidemia, hypertension, and obesity. The 12-year cardiovascu lar mortality of men screened in the Multiple Risk Factor Interven tion Trial (MRFIT) showed that diabetic patients consistently had higher cardiovascular mortality than non-diabetic men matched for one or more of the major risk factors for CVD. 5 The data from the