Forty-four Years of the UK Prospective Diabetes Study: Legacy Effect and Beyond.

The results of the third phase of the UK Prospective Diabetes Study, recently published in The Lancet, reinforce the crucial role of early intensive glycaemic control in protection against micro- and macrovascular complications of diabetes. The benefits persist into the third decade after the completion of the trial, long after the difference in glycated haemoglobin between the intensive and standard arms has disappeared. This 'legacy effect' emphasizes the need for early diagnosis and aggressive management of diabetes from the time of its identification. It also validates the long-term safety and efficacy of conventional agents such as metformin and sulfonylureas. Understanding the mechanisms behind the 'legacy effect' could help target pathways that lead to the development of complications.