title: [Glycaemic control and complications of diabetes: what about?].
abstract: In France, 2.8 millions of patients have type 2 diabetes, which is a well-established risk factor for cardiovascular disease. In about 15 years, several large clinical trials tried to study the relationship between a tight glycaemic control and the occurrence of micro- and macroangiopathy. Meta-analyses of targeting intensive versus conventional glycaemic control focused on divergent results. In type 1 diabetes, a tight glycaemic control reduced the occurrence of microangiopathy whereas more time, at least 5 years is needed to reduce macroangiopathy. Conclusions drawn from studies are less clear for type 2 diabetes and depend on the caracteristics of the population studied, particularly for retinopathy. When microalbuminuria is the judgement criteria, its progression is lower in the intensive group than in the conventional one and it takes more than about 5 years to emerge; the impact on glomerular filtration rate is less clear. Worries about the excess of mortality observed in the ACCORD study in the intensive treatment group were not described in other studies. The decrease of mortality was not associated with an intensive glyceamic control. Intensified multifactorial intervention is finally needed to improve microangiopathy.
authors.affiliation: CHU de Rangueil, service d'HTA et médecine interne TSA 50 032, 31059 Toulouse cedex 9, France. duly-bouhanick.b@chu-toulouse.fr
authors.forename: Béatrice
authors.initials: B
authors.lastname: Bouhanick
authors.forename: Mohamed
authors.initials: M
authors.lastname: Barigou
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Kantambadouno
authors.forename: Bernard
authors.initials: B
authors.lastname: Chamontin
mesh_terms: D000419:Albuminuria / Q000209:etiology; D001786:Blood Glucose / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality; D048909:Diabetes Complications / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D018450:Disease Progression; D005602:France / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D008017:Life Expectancy; D015201:Meta-Analysis as Topic; D015337:Multicenter Studies as Topic; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin