title: [Glycemic targets and cardiovascular morbi-mortality].
abstract: The 2008-year was full of learning experience and suspense in diabetologia. The past studies, UKPDS in type 2 diabetic patients and DCCT in type 1 diabetic patients have shown that intensive treatment during a short period did reduce the incidence of microvascular events and in the long term, the incidence of macrovascular events linked to diabetes. The conclusions of recent studies quote, from ACCORD, an increased mortality in the type 2 diabetic patients using intensive therapy, from ADVANCE, a reduction of microvascular complications and from VADT, no effect. The analysis of studies published since 2008 brings lessons for the clinical practice: presence of glycemic memory, absence of tensional memory, usefulness of control of every cardiovascular risk factors, need of early treatment of diabetes. Moreover, to define HbA1c objective, age, duration of diabetes, presence of cardiovascular risk factors, former HbA1c level and potential undesirable effects, such hypoglycaemia, must be considered. The management of type 2 diabetic patients requires an early, not to quick intensive treatment, which avoids hypoglycaemia and is combined with a strict control of cardiovascular risk factors. So, the recent position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consideres needs and preferences of each patient and individualizes glycemic targets and treatments.
authors.affiliation: Hôpital d'instruction des Armées Bégin, service d'endocrinologie, 94160 Saint-Mandé, France. lbordier@club-internet.fr
authors.forename: Lyse
authors.initials: L
authors.lastname: Bordier
authors.forename: Bernard
authors.initials: B
authors.lastname: Bauduceau
mesh_terms: D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D048909:Diabetes Complications / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy; D042241:Early Diagnosis; D005060:Europe / Q000453:epidemiology; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006040:Goals; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007003:Hypoglycemia / Q000139:chemically induced / Q000401:mortality; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors; D012955:Societies, Medical / Q000592:standards
chemical_list: D000959:Antihypertensive Agents; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents