Glucose control guidelines: current concepts.
The Diabetes Control and Complications Trial (DCCT) ended decades of controversy regarding the necessity of tight glycemic control for type 1 diabetes by demonstrating that glucose control using intensive insulin therapy significantly reduced long-term microvascular complications. The American Diabetes Association (ADA) guidelines empirically support the same goal of attempting to obtain normoglycemia in patients with type 2 disease; however, unlike in type 1 disease, insulin is a tertiary option, following diet, exercise, and oral agents. Emerging long-term intervention data in type 2 diabetes suggest that insulin may pose increased cardiovascular risk in this already 'at-risk' population. However, many type 2 diabetics will eventually require insulin. Clearly, more studies are warranted to assess the risks, benefits, and feasibility of improved glycemic control in type 2 diabetes. Nonetheless, two principles are clear. First, promoting blood glucose levels approaching normoglycemia is an important factor in preventing long-term microvascular complications. Second, type 2 diabetes comprises numerous metabolic conditions; therefore an integrated effort by the patient and healthcare team is required to optimize blood glucose and serum lipid levels and minimize cardiovascular risk factors.
Barranco
J G
JG
Department of Endocrinology, National Institute of Nutrition SZ, Vasco de Quiroga No. 15, Mexico City ZC 14000.
D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000378:metabolism / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000378:metabolism / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000517:prevention & control; D003927:Diet, Diabetic; D015444:Exercise; D017408:Guidelines as Topic; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D012307:Risk Factors
D001786:Blood Glucose; D007004:Hypoglycemic Agents