Controlling blood glucose levels in patients with type 2 diabetes mellitus. An evidence-based policy statement by the American Academy of Family Physicians and American Diabetes Association.
OBJECTIVE
To review evidence about the benefit of intensive glycemic control for patients with type 2 diabetes and to develop practice recommendations.


METHODS
A 9-member panel composed of family physicians, general internists, endocrinologists, and a practice guidelines methodologist was assembled by the American Academy of Family Physicians, the American Diabetes Association, and the American College of Physicians.


METHODS
Admissible evidence included published randomized controlled trials and observational studies regarding the effects of glycemic control on microvascular and macrovascular complications and on adverse effects. We followed systematic search and data abstraction procedures. Greater weight was given to clinical trials and to evidence about health outcomes.


METHODS
Interpretations of evidence and approval of documents were finalized by unanimous vote, with recommendations linked to evidence and not expert opinion. The full report was prepared by the chair and 2 panel members, representing each of the 3 organizations. The initial draft underwent external review by 14 diabetologists and family physicians and changes consistent with the evidence were incorporated.


CONCLUSIONS
The evidence demonstrates that the risk of microvascular and neuropathic complications is reduced by lowering glucose concentrations. Whether glycemic control affects macrovascular outcomes is less clear. The potential benefits of glycemic control must be balanced against factors that either preempt benefits (eg, limited life expectancy, comorbid disease) or increase risk (eg, severe hypoglycemia). The magnitude of benefit is a function of individual clinical variables (eg, baseline glycated hemoglobin level, presence of preexisting microvascular disease). Appropriate targets for treatment should be determined by considering these factors, patients' risk profiles, and personal preferences.
Woolf
S H
SH
Department of Family Medicine, Medical College of Virginia-Virginia Commonwealth University, Richmond, USA. SHWoolf@aol.com
Davidson
M B
MB
Greenfield
S
S
Bell
H S
HS
Ganiats
T G
TG
Hagen
M D
MD
Palda
V A
VA
Rizza
R A
RA
Spann
S J
SJ
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D003925:Diabetic Angiopathies / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012306:Risk; D016896:Treatment Outcome
D001786:Blood Glucose