title: Treatment of the patient with diabetes: importance of maintaining target HbA(1c) levels.
abstract: OBJECTIVE
  To review clinical trial evidence supporting treatment of patients to a near-normal HbA(1c) target level and outline therapeutic strategies that optimize glycemic control.
  
  
  METHODS
  The current MEDLINE database and bibliographies were searched for literature relevant to diabetic complications, glycemic control, and the intensive management of diabetes mellitus.
  
  
  RESULTS
  Two randomized trials, the Diabetes Control and Complications Trial and the UK Prospective Diabetes Study (UKPDS), provided evidence that intensive glycemic control obtained with either intensive insulin or oral therapy effectively slowed the onset and progression of diabetic retinopathy, nephropathy, and neuropathy in patients with type 1 and type 2 diabetes. An epidemiologic analysis of the UKPDS results showed a significant correlation between glycemic control and microvascular and cardiovascular disease risk and mortality rates.
  
  
  CONCLUSIONS
  The results of clinical trials confirm that stringent levels of glycemic control can be attained through the use of intensive multiple-injection insulin regimens (administration of insulin 3 or more times daily by injection or an external pump with dosage adjustments as needed), oral monotherapy or combination therapy, or a combination of insulin and oral therapy. The expanded choices for oral agents and the availability of insulin analogs now provide physicians with the tools to tailor therapy to prevent or delay the devastating complications of diabetes. Indeed, newer insulin analogs, both short-acting (insulin lispro, insulin aspart) and long-acting (insulin glargine), are an important part of a treatment strategy to circumvent diabetes complications and overcome the shortcomings of conventional insulin preparations.
authors.affiliation: Endocrine and Diabetes Associates of Texas, Dallas, TX 75230, USA. Endodiab@medicalcitydallas.com
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Davidson
mesh_terms: D001786:Blood Glucose; D048909:Diabetes Complications / Q000517:prevention & control*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy*; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D011379:Prognosis
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin