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Results for “Glycemic Control”

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At least 397 records · Page 22Linked to original sources

PubMed2004

Closing the gap: effect of diabetes case management on glycemic control among low-income ethnic minority populations: the California Medi-Cal type 2 diabetes study.

OBJECTIVE: Disparities exist in the diabetes health status of ethnic minority and/or low-income populations relative to other groups. A primary objective of diabetes management is to improve glycemic control. The feasibility of implementing intensive diabetes case management in disparate populations remains largely untested. RESEARCH DESIGN AND METHODS: Clinical sites in three southern California counties serving low-income, ethnic minority populations participated in our study. We randomized 362 Medicaid (called Medi-Cal in California) recipients with type 2 diabetes for at least 1 year to intervention (diabetes case management) or control (traditional primary care treatment) groups. Fifty-five percent of participants were minorities. Participants with HbA(1c) levels less than 7.5%, serious diabetes-related complications, or other serious medical conditions were excluded. We assessed the effect of the intervention (ongoing diabetes case management added to primary care) on glycemic control using serial HbA(1c) measurements over several years. RESULTS: The mean duration of follow-up was 25.3 months. HbA(1c) decreased substantially in both groups from an average of 9.54-7.66% (a reduction of 1.88%) in the intervention group and from an average of 9.66-8.53% (a reduction of 1.13%) in the control group. This improvement was sustained throughout the study. The reduction in HbA(1c) was consistently greater in the intervention group at each time point (P < 0.001), ranging between 0.65 at 6 months and 0.87 at study end. CONCLUSIONS: Diabetes case management, added to primary care, substantially improved glycemic control compared with the control group. Diabetes case management can help reduce disparities in diabetes health status among low-income ethnic populations.

Blood Glucose↗

PubMedDate not supplied

[Family-physician factors associated with glycemic control of patients with diabetes mellitus].

INTRODUCTION: Metabolic control of patients with diabetes is determined by several factors, among others competence level, performance, and attitudes of primary-care physicians. OBJECTIVE: On objective was to determinate family physician factors associated with glycemic control in subjects with diabetes in two Family Medicine Units (FMU). DESIGN: Cross-sectional comparative study. SETTING: Two Family Medicine Units of the Mexican Institute Social Security. INTERVENTIONS: Family physician demographic factors were measured (age, sex, job seniority, time of university graduation, and had to have studied a specialty residence studied). Two validated instruments were applied to measure attitude level and handling competence of DM 2, and we determined glycemic level in the previous months of five diabetic patients by consulting room. RESULTS: Forty family physicians were evaluated, mean age 43.9 years, 57.5% with a residence in Family Medicine. Better glycemic control was associated with job seniority, OR 2.49 (CI 0.96-6.6), time of university graduation > 10 years with OR 2.11 (CI 1.4-2.9), to have at least one course related with diabetes in the previous year with OR 4.8 (IC 0.39-22), and competence level OR 2.02 (CI 0.36-11.3) CONCLUSIONS: There association between better glycemic control and more professional experience and training on diabetes in the previous year.

Adult↗

PubMed1982

Glycemic control in pregnant diabetic women using a continuous subcutaneous insulin infusion pump.

Five insulin-dependent diabetics in the third trimester of pregnancy were first stabilized on morning and evening injections of both short- and long-acting insulin. Blood sugars were determined hourly from 7 A.M. to 7 P.M. and then every two hours from 7 P.M. to 7 A.M. After glycemic control was established, the patients were treated with continuous subcutaneous insulin infusion via a pump that administers a basal dosage at predetermined intervals and bolus doses preprandially. Mean blood sugar, glycemic excursions and intervals of hypoglycemia and hyperglycemia were calculated after three to five days of infusion therapy. The continuous subcutaneous insulin infusion with the pump did not improve glycemic control in the group as a whole, but in two of five patients there was a significant decrease in mean blood sugar. A trend towards a decrease in glycemic excursions as well as hypoglycemia and hyperglycemia was also obtained. Three patients were managed with long-term home and in-hospital use of the continuous subcutaneous insulin infusion pump. It proved to be efficacious and safe in establishing euglycemia. This study of a portable insulin infusion pump affirms its ability to maintain glycemic control and its safety for long-term therapy during pregnancy.

Diabetes Mellitus↗

PubMed2004

A prospective study of glycemic control during holiday time in type 2 diabetic patients.

OBJECTIVE: In the U.K. Prospective Diabetes Study, A1C increased from 1.2 to 1.7% and fasting plasma glucose from 1.0 to 2.8 mmol/l over 10 years in type 2 diabetic patients. It is not known whether the blood glucose increase observed in long-term studies of type 2 diabetes results from small, steady increases throughout the year or from increases during discrete periods. RESEARCH DESIGN AND METHODS: To estimate the variation of actual glycemic control and its relation to holiday times, we measured A1C and fructosamine in 110 patients with type 2 diabetes. These measurements were performed four times at intervals of 4-6 weeks; therefore, glycemic change was determined for three periods: preholiday period (from between November 13 and December 20 to between December 20 and January 20), holiday period (from between December 20 and January 20 to between January 28 and February 28), and postholiday period (from between January 28 and February 28 to between March 1 and April 10). A final measurement of A1C was obtained from 90 subjects in the following December or January. RESULTS: The mean A1C increased, but not significantly, during the preholiday (increase 0.135 +/- 0.723%, P = 0.055) and holiday (increase 0.094 +/- 0.828%, P = 0.239) periods. The mean A1C decreased, but not significantly, during the postholiday period (decrease 0.022 +/- 0.588%, P = 0.695). Altogether, the A1C change during these three periods increased significantly (increase 0.207 +/- 0.943%, P = 0.024). The mean fructosamine increased significantly during the preholiday period (increase 0.151 +/- 0.460 mmol/l, P = 0.001), but there was no significant change during the holiday period (increase 0.057 +/- 0.593 mmol/l, P = 0.321). However, fructosamine decreased significantly during the postholiday period (decrease 0.178 +/- 0.448 mmol/l, P < 0.001). Altogether, the fructosamine changes during the study periods showed no significant difference (increase 0.030 +/- 0.566 mmol/l, P = 0.579). Between March or early April and the following December or January, there was no additional change in A1C (decrease 0.009 +/- 1.039%, P = 0.935) for the 90 participants who returned for follow-up treatment. CONCLUSIONS: The present study demonstrates an influence of winter holidays on the glycemic control of patients who have type 2 diabetes, and this poor glycemic control might not be reversed during the summer and autumn months. Therefore, the cumulative effects of the yearly A1C gain during the winter holidays are likely to contribute to the substantial increase in A1C that occurs every year among type 2 diabetic individuals.

Adult↗

PubMed2005

Effects of garlic oil and diallyl trisulfide on glycemic control in diabetic rats.

We investigated the effects of garlic oil and diallyl trisulfide on glycemic control in rats with streptozotocin-induced diabetes. Diabetic rats received by gavage garlic oil (100 mg/kg body weight), diallyl trisulfide (40 mg/kg body weight), or corn oil every other day for 3 weeks. Control rats received corn oil only. Both garlic compounds significantly raised the basal insulin concentration. The insulin resistance index as assessed by homeostasis model assessment and the first-order rate constant for glucose disappearance were significantly improved by both garlic compounds (P<0.05). Oral glucose tolerance was also improved by both garlic compounds and was accompanied by a significantly increased rate of insulin secretion (P<0.05). Glycogen formation (but not that of lactate or carbon dioxide) from glucose by the soleus muscle in the presence of 10 or 100 microU/ml of insulin was significantly better after treatment with both garlic compounds. Both garlic oil and diallyl trisulfide improve glycemic control in diabetic rats through increased insulin secretion and increased insulin sensitivity.

Allyl Compounds↗

PubMed1991

Uteroplacental Doppler flow velocity waveform analysis correlates poorly with glycemic control in diabetic pregnant women.

We examined 65 pregnant women with gestational (n = 31) and insulin dependent (n = 34) diabetes mellitus in order to evaluate the clinical usefulness of Doppler flow velocity waveform analysis in these pregnancies. Umbilical and uterine artery flow velocity waveforms were obtained during the third trimester with a continuous wave Doppler device. Quality of maternal glycemic control was evaluated by hemoglobin (Hb) A1 measurements at the time of delivery in 61 patients and by mean capillary blood sugars during the third trimester of pregnancy in four patients. There was no difference in various clinical and Doppler parameters between patients with good glycemic control and those with poor control. In contrast, the same clinical and Doppler parameters were significantly different in patients with preeclampsia than in those without preeclampsia, regardless of glycemic control. There was a poor positive linear correlation (r = 0.30, p less than 0.02) between maternal HbA1 and umbilical artery flow velocity waveforms (systolic/diastolic ratio). Proteinuria correlated better with umbilical artery systolic/diastolic ratio (r = 0.49, p less than 0.001). We conclude that Doppler flow velocity waveform analysis may be clinically useful only in diabetic pregnancies complicated by preeclampsia.

Adult↗

PubMedDate not supplied

Glycosylated hemoglobin and fasting plasma glucose in the assessment of outpatient glycemic control in NIDDM.

Interpreting measurements of fasting plasma glucose (FPG) and glycosylated hemoglobin (GHb) is subject to inherent limitations. The time course of change in GHb cannot be reliably specified in the individual patient, nor do single measurements of GHb convey any information regarding recent change or stability in glycemic control. To evaluate whether the clinical utility of these measurements may be extended, sequential measurements of FPG and GHb were examined from 16 outpatients with NIDDM followed over periods of 12 successive weeks or longer, including intervals following cessation of prior therapy or initiation of new hypoglycemic therapy with glipizide. In some individuals as well as groups of patients, changes in GHb followed patterns previously described by mean changes among groups of patients. Differing from those patterns, however, other individuals demonstrated prompt improvement in GHb following substantial improvement in FPG, confirming that patterns of change described from group means do not apply to all circumstances of changing glycemic control, though they may represent the most common. By using measurements of both FPG and GHb obtained on a single occasion to calculate a third parameter, called the glycosylated hemoglobin index (GHb-1), accurate information could be obtained regarding changes in glycemic control which occurred over intervals of 1-4 wk prior to the measurements. By this approach the utility of GHb measurements in the management of outpatients with NIDDM may be extended beyond retrospective description of the "average" prior metabolic control to include assessment of recent changes in glycemia, either deterioration or improvement.

Aged↗

PubMedDate not supplied

Glycemic control in patients with type I diabetes and normoalbuminuria after long diabetes duration.

The importance of glycemic control for the avoidance of micro- and macroalbuminuria after a diabetes duration of 20 years or more was studied in type I (insulin-dependent) diabetic patients diagnosed before an age of 31 years. Glycemic control was assessed as glycated hemoglobin for 5 years or more, on average 9.8 years with 3.2 measurements per year. Of the 197 included patients, 97 men and 100 women, 112 were normoalbuminuric, 45 had microalbuminuria (20-200 mg/L), and 40 had macroalbuminuria (persistent albuminuria > 200 mg/L). Normoalbuminuric patients had a mean HbA1c +/- SEM for the whole measurement period of 6.9 +/- 0.08%, the microalbuminuric patients 7.3 +/- 0.14% (Mann-Whitney test versus normoalbuminuric group, p = 0.025), and macroalbuminuric patients 7.6 +/- 0.13 (p < 0.001). The patients were on average 45 years old, and had an age at onset of 14 years, without significant differences between the groups. Thirteen patients had regressed from macroalbuminuria to normo- (n = 6) or microalbuminuria (n = 7). Of the normoalbuminuric patients, 43% were male, compared to 44% with microalbuminuria and 73% with macroalbuminuria (chi 2, p = 0.026). Logistic regression, with absence of albuminuria as dependent variable, showed a beneficial impact from lower HbA1c and normal blood pressure (blood pressure < 140/90 mm Hg without antihypertensive treatment). In conclusion, these results suggests that absence of albuminuria after 20 years or more of diabetes is associated with lower HbA1c.

Adult↗

PubMed1994

Strict glycemic control in women with pregestational insulin-dependent diabetes mellitus.

OBJECTIVE: To determine the efficacy of strict glycemic control in women with pregestational insulin-dependent diabetes mellitus (IDDM). METHODS: The records of 62 pregnant women with pregestational IDDM who had attended the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Virgen de las Nieves General Hospital, Granada, Spain, between 1982 and 1992, were reviewed. The women had received several daily doses of a mixture of rapid action (regular) and intermediate action insulin with the aim of keeping preprandial glucose levels lower than 95 mg/dl and postprandial glucose levels lower than 120 mg/dl. Perinatal outcomes were compared with those of a control group consisting of 96 randomly selected, normal, pregnant women who gave birth at approximately the same time. RESULTS: Mean glycemic profile in the first assay at an insulin dose of 33.1 +/- 15.9 IU/day was 153.7 +/- 52.3 mg/dl and the HbA1c was 7.7 +/- 2.3%. In the last assay before delivery patients received an insulin dose of 68.2 +/- 30.7 IU/day and had a mean glycemic profile of 94.4 +/- 18.1 mg/dl and an HbA1c of 5.9 +/- 1.4% (P < 0.001 for all parameters). The perinatal mortality of newborn infants of the diabetic mothers was 48 per 1000, and 11.3 per 1000 had some congenital malformations. CONCLUSIONS: Our results verify that strict glycemic control decreases the elevated perinatal mortality normally suffered by IDDM patients. However, if it is to reduce the number of congenital malformations, it must be initiated before the early gestational stages.

Adult↗

PubMedDate not supplied

Errors in clinical assessment of glycemic control in patients with non-insulin-dependent diabetes mellitus.

Errors in the assessment of glycemic control by clinicians, using the conventional method, based on random blood glucose and clinical parameters other than HbA1, were assessed in 125 non-insulin-dependent diabetic (NIDDM) patients (Group B). The expected mean post-prandial plasma glucose concentrations (y) for these patients were obtained from their HbA1 values (x) using the regression equation y = 39.6 X x - 157.6. This equation was derived using the data from 35 NIDDM patients (Group A), in whom mean post-prandial plasma glucose concentrations (measured twice daily), correlated excellently (r = 0.82; n = 100; p less than 0.001) with mean HbA1 values (measured monthly) determined over a period of 3 months. A comparison of the observed and expected post-prandial plasma glucose concentrations in Group B indicated that only an overall 42% of the total (n = 455) observed values (as against 60% in Group A) fell within the 99% confidence limits of the expected mean value. Fifty-eight % of the observed plasma glucose values fell outside the expected range of which 36% were underestimates and 22% were overestimates. Thus, we concluded that even in patients with stable diabetes the physician's assessment of the overall degree of glycemic control should be based on both plasma glucose and HbA1 concentrations for optimizing therapeutic measures.

Blood Glucose↗

PubMed2001

The impact of pioglitazone on glycemic control and atherogenic dyslipidemia in patients with type 2 diabetes mellitus.

BACKGROUND: To evaluate the glycemic control, lipid effects, and safety of pioglitazone in patients with type 2 diabetes mellitus. DESIGN AND METHODS: Patients (n = 197) with type 2 diabetes mellitus, a hemoglobin A1c (HbA1c) > or = 8.0%, fasting plasma glucose (FPG) > 7.7 mmol/l (140 mg/dl), and C-peptide > 0.331 nmol/l (1 ng/ml) were enrolled in this 23-week multi-center (27 sites), double-blind clinical trial and randomized to receive either a placebo or pioglitazone HCl 30 mg (pioglitazone), administered once daily, as monotherapy. Patients were required to discontinue all anti-diabetic medications 6 weeks before receiving study treatment. Efficacy parameters included HbA1c fasting plasma glucose (FPG), serum C-peptide, insulin, triglycerides (Tg), and cholesterol (total cholesterol [TC], high-density lipoprotein-cholesterol [HDL-C], low-density lipoprotein-cholesterol [LDL-C]). Adverse event rates, serum chemistry, and physical examinations were recorded. RESULTS: Compared with placebo, pioglitazone significantly (P= 0.0001) reduced HbA1c (-1.37% points), FPG (-3.19 mmol/l; -57.5 mg/dl), fasting C-peptide (-0.076+/-0.022 nmol/l), and fasting insulin (-11.88+/-4.70 pmol/l). Pioglitazone significantly (P < 0.001) decreased insulin resistance (HOMA-IR; -12.4+/-7.46%) and improved beta-cell function (Homeostasis Model Assessment (HOMA-BCF); +47.7+/-11.58%). Compared with placebo, fasting serum Tg concentrations decreased (-16.6%; P = 0.0178) and HDL-C concentrations increased (+12.6%; P= 0.0065) with pioglitazone as monotherapy. Total cholesterol and LDL-C changes were not different from placebo. The overall adverse event profile of pioglitazone was similar to that of placebo, with no evidence of drug-induced elevations of serum alanine transaminase (ALT) concentrations or hepatotoxicity. CONCLUSIONS: Pioglitazone improved insulin resistance and glycemic control, as well as Tg and HDL-C - which suggests that pioglitazone may reduce cardiovascular risk for patients with type 2 diabetes.

Adult↗

PubMed2004

Residual beta-cell function more than glycemic control determines abnormalities of the insulin-like growth factor system in type 1 diabetes.

The GH-IGF-I axis is disturbed in patients with type 1 diabetes. Our aim was to investigate whether abnormalities are found in patients in very good glycemic control and, if so, to estimate the role of residual beta-cell function. Patients with hemoglobin A1c (HbA1c) less than 6% (reference range, 3.6-5.4%) were selected for the study. Twenty-two men and 24 women, aged 41.3 +/- 13.8 yr (mean +/- SD), with a diabetes duration of 17.8 +/- 14.6 yr participated. Healthy controls (15 women and nine men), aged 41.3 +/- 13.0 yr, were also studied. Overnight fasting serum samples were analyzed for HbA1c, C peptide, free and total IGFs, IGF-binding proteins (IGFBPs), GH-binding protein, and IGFBP-3 proteolysis. HbA1c was 5.6 +/- 0.5% in patients and 4.4 +/- 0.3% in controls. Total IGF-I was 148 +/- 7 microg/liter in patients and 178 +/- 9 microg/liter in controls (P < 0.001). Free IGF-I, total IGF-II, IGFBP-3, and GH-binding protein were lower, whereas IGFBP-1, IGFBP-1-bound IGF-I, and IGFBP-2 were elevated compared with control values. Patients with detectable C peptide (> or =100 pmol/liter) had higher levels of total IGF-I, free IGF-I, and total IGF-II and lower levels of IGFBP-1 and IGFBP-2 than those with an undetectable C peptide level despite having identical average HbA1c. IGFBP-3 proteolysis did not differ between patients and controls. Despite very good glycemic control, patients with type 1 diabetes and no endogenous insulin production have low free and total IGF-I. Residual beta-cell function, therefore, seems more important for the disturbances in the IGF system than good metabolic control per se, suggesting that portal insulin delivery is needed to normalize the IGF system.

Adult↗

PubMed2003

Fenofibrate treatment is associated with better glycemic control and lower serum leptin and insulin levels in type 2 diabetic patients with hypertriglyceridemia.

Background: Hertriglyceridemia is commonly encountered in type 2 diabetic patients. Fibrates are a group of drugs that efficiently decrease triglycerides, increase HDL, and improve the prognosis in both diabetic and nondiabetic patients. However, the effects of fibrates on glycemic control, blood pressure, fasting serum insulin, and leptin concentrations are not clear. The present study addresses the question of whether fenofibrate treatment in hypertriglyceridemic type 2 diabetic patients leads to changes in metabolic control, body mass index, leptin, free fatty acids, plasma insulin, and blood pressure. Methods: Thirty-one type 2 diabetic patients who had serum triglyceride levels between 250 and 400 mg/dl were included in the study. They were given 250 mg/day fenofibrate once daily for 3 months. Antidiabetic and antihypertensive treatments were kept unchanged throughout the study. Results: Fenofibrate treatment resulted in better glycemic control, as evidenced by lower fasting and postprandial blood glucose and HbAlc, decreased fasting serum insulin and leptin levels, as well as a reduction in hypertrigyceridemia and serum free fatty acids, and an increase in HDL cholesterol. Blood pressure, body mass index, and LDL remained unchanged. Fenofibrate was well tolerated in all patients. Conclusion: Fenofibrate treatment in hypertriglyceridemic type 2 diabetic patients is beneficial not only in terms of lipid profile, but also for glycemic control and insulin resistance.

Journal Article↗

PubMed2001

Differences in glycemic control and cardiovascular risk in primary care patients with type 2 diabetes in West Indies.

There are limited resources and facilities at primary care clinics in most developing countries. Medical professionals are often faced with the challenges of providing standard health care delivery in the absence of adequate resources. We aimed to evaluate the long-term glycemic control and risk of cardiovascular disease in multi-ethnic groups of diabetic patients attending primary care clinics in Trinidad. One hundred and ninety-one (127 females, 64 males, mean age 56.6 years) patients with type 2 diabetes (mean duration 9.2 years) attending primary care clinics in Trinidad were studied after a 12 to 14-h overnight fast. Weight, height, waist and hip circumferences, and blood pressure were measured, and a blood sample was taken for glucose, glycated hemoglobin, total cholesterol, triglycerides, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol. and creatinine determinations. About 85% of patients had glycated hemoglobin levels >7.0%, 31% had central obesity, 49% had diastolic blood pressure >83 mmHg, while 40% had a total-cholesterol/high-density lipoprotein-cholesterol ratio greater than 6. In comparison with males, female patients had significantly higher levels of total-cholesterol and low-density lipoprotein-cholesterol independent of obesity (P<0.01) while male patients of East Indian descent had the highest risk of cardiovascular disease compared with males of any other ethnic group (P<0.01). In conclusion patients with type 2 diabetes attending primary care clinics in Trinidad had poor glycemic control. Female and male patients of Indian ethnic group were at the highest risk of cardiovascular disease. Efforts at strict glycemic control and protection against microvascular complications should be intensified at primary care levels.

Cardiovascular Diseases↗

PubMed2005

Promoting glycemic control through diabetes self-management: evaluating a patient activation intervention.

This study compared an activation intervention to passive education in a randomized attention-control trial of 232 patients with type 2 diabetes. The activation intervention was based on Expanding Patient Involvement in Care (EPIC) trials, and was compared to time-matched passive education viewing of ADA video-tapes. Patient demographics and clinical characteristics of their diabetes were assessed with questionnaires, active involvement was assessed via ratings of taped interactions between patients and providers, and serum samples were analyzed for HbA1c. Patients in the activation condition were rated as more actively involved in discussions of diabetes self-management, and rated active involvement was predictive of improvement in glycemic control. No effect of the activation intervention was found on HbA1c. Thus, the activation intervention increased the active involvement of patients with type 2 diabetes in visits with practitioners, and active involvement led to improved glycemic control. However, the activation intervention did not improve glycemic control directly.

Blood Glucose Self-Monitoring↗

PubMed2006

Low-carbohydrate diet in type 2 diabetes. Stable improvement of bodyweight and glycemic control during 22 months follow-up.

BACKGROUND: Low-carbohydrate diets in the management of obese patients with type 2 diabetes seem intuitively attractive due to their potent antihyperglycemic effect. We previously reported that a 20% carbohydrate diet was significantly superior to a 55-60% carbohydrate diet with regard to bodyweight and glycemic control in 2 non-randomised groups of obese diabetes patients observed closely over 6 months. The effect beyond 6 months of reduced carbohydrate has not been previously reported. The objective of the present study, therefore, was to determine to what degree the changes among the 16 patients in the low-carbohydrate diet group at 6-months were preserved or changed 22 months after start, even without close follow-up. In addition, we report that, after the 6 month observation period, two thirds of the patients in the high-carbohydrate changed their diet. This group also showed improvement in bodyweight and glycemic control. METHOD: Retrospective follow-up of previously studied subjects on a low carbohydrate diet. RESULTS: The mean bodyweight at the start of the initial study was 100.6 +/- 14.7 kg. At six months it was 89.2 +/- 14.3 kg. From 6 to 22 months, mean bodyweight had increased by 2.7 +/- 4.2 kg to an average of 92.0 +/- 14.0 kg. Seven of the 16 patients (44%) retained the same bodyweight from 6 to 22 months or reduced it further; all but one had lower weight at 22 months than at the beginning. Initial mean HbA1c was 8.0 +/- 1.5%. After 6 and 12 months it was 6.6 +/- 1.0 % and 7.0 +/- 1.3%, respectively. At 22 months, it was still 6.9 +/- 1.1%. CONCLUSION: Advice on a 20% carbohydrate diet with some caloric restriction to obese patients with type 2 diabetes has lasting effect on bodyweight and glycemic control.

Journal Article↗

PubMed1993

Metaanalysis of the effects of intensive glycemic control on late complications of type I diabetes mellitus.

OBJECTIVE: To estimate the effects of intensive glycemic control on the progression of diabetic retinopathy and nephropathy, and to assess the risks of severe hypoglycemia and diabetic ketoacidosis. DESIGN: Metaanalysis of published randomized controlled trials. SETTING: As listed in each study. PATIENTS: Five hundred twenty-nine patients from 16 randomized controlled trials. MEASUREMENTS: We searched for all studies with sufficient data for analysis. The overall difference in the risk of retinopathy or nephropathy progression was analyzed, and the overall difference in the incidence of hypoglycemia or diabetic ketoacidosis was estimated. RESULTS: Compared to conventionally treated patients, the risk of retinopathy progression was statistically insignificantly higher after 6 to 12 months of intensive therapy (odds ratio [OR] 2.11; 95% confidence interval [CI], 0.54 to 8.31). After more than 2 years of intensive therapy the risk of retinopathy progression was lower (OR 0.49; 95% CI, 0.28 to 0.85). The risk of nephropathy progression was also decreased significantly in the intensive therapy group (OR 0.32; 95% CI, 0.19 to 0.55). When compared to conventional control, intensive therapy reduced glycosylated hemoglobin (%) by 1.4 with a 95% CI ranging from 1.1 to 1.8. The overall incidence of severe hypoglycemia increased by 9.1 episodes/100 person-years (95% CI, -1.4 to 19.6) in the intensively treated patients. The incidence of diabetic ketoacidosis increased by 12.6 episodes/100 person-years (95% CI, 8.7 to 16.5) in those who received continuous subcutaneous insulin infusion. CONCLUSION: Long-term intensive glycemic control significantly reduced the risks of diabetic retinopathy and nephropathy progression among type I diabetes patients when compared with randomly assigned controls. However, long-term continuous subcutaneous insulin infusion was associated with an increased incidence of diabetic ketoacidosis, and intensive therapy might cause more severe hypoglycemic reactions in some patients.

Blood Glucose↗

PubMed2003

Treating the diabetic patient: appropriate care for glycemic control and cardiovascular disease risk factors.

Diabetes, a leading cause of morbidity and mortality in the United States, is associated with a 2- to 4-fold increase in the risk of coronary artery disease. As the population in the United States has aged, the incidence of obesity, hypertension, glucose intolerance, and dyslipidemia has increased significantly, culminating in the current epidemic of type 2 diabetes mellitus. Strict glycemic control must, therefore, be accompanied with proven therapies (such as antihypertensives and lipid-lowering agents) to reduce cardiovascular events. Patients with type 2 diabetes have average low-density lipoprotein (LDL) levels but have an increased number of small, dense LDL particles, which are associated with a 3-fold increase in cardiovascular disease. Type 2 diabetes mellitus is also associated with increased triglyceride rich atherogenic particles, which trigger inflammation. In addition to glycemic control and drug therapy, lifestyle modifications (eg, diet, weight loss, and exercise) also play an important role in managing diabetes. Therefore, strict glycemic control, pharmacologic therapy, and lifestyle modifications are parts of a comprehensive strategy to prevent both microvascular and macrovascular events in patients with type 2 diabetes.

Angiotensin-Converting Enzyme Inhibitors↗