Control of Blood Glucose and Diabetic Vascular Disease

Siperstein, Marvin D.; Foster, Daniel W.; Knowles, Harvey C.; Levine, Rachmiel; Madison, Leonard L.; Roth, Jesse

doi:10.1056/nejm197705052961812

Cited by 157 publications

(52 citation statements)

References 22 publications

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“…In insulin-treated diabetic patients who nowadays hope for a long life expectancy without physiological or social handicaps, an improvement of control will probably be beneficial in lowering the occurrence and severity of microangiopathy [15], although the relationship between blood glucose control and the evolution of microvascular disease in diabetes is still under discussion [1,2]. The results of this study may indicate that the desire for better control does not increase the social restrictions placed on the diabetic or the risk of more frequent hypoglycaemic reactions.…”

Section: Discussionmentioning

confidence: 99%

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The risk of diabetic control: A comparison of hospital versus general practice supervision

Basdevant

Costagliola

et al. 1982

Diabetologia

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Summary. Two groups of insulin-treated outpatients (one followed up at the Hotel-Dieu Hospital and the second mainly supervised by general practitioners) were chosen at random in 1978. The two populations were comparable in age, age at diagnosis, sex, level of education, overall activity and socio-professional and economic status. Outpatients followed up in the diabetic unit had better blood glucose control, with about the same number of hypoglycaemic reactions as patients followed up in general practice. This better control was associated with more social activity and less visits to the physician, despite the fact that patients attending the hospital spent more money on their diet and had more daily insulin injections. All these differences remain significant after adjustment for the duration of diabetes. It may be inferred that attempts to improve control in insulin-treated patients are associated with a more active life and with no increase in the frequency of hypoglycaemic reactions.

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Section: Discussionmentioning

confidence: 99%

“…Following several controversial publications on the control of diabetes [1,2], Ingelfinger [3] stressed that 'almost nothing is known of the risks, in particular hypoglycaemia, of attempting to implement control'.…”

mentioning

confidence: 99%

The risk of diabetic control: A comparison of hospital versus general practice supervision

Basdevant

Costagliola

et al. 1982

Diabetologia

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“…Although it is generally believed that strict metabolic control delays the development of late complications in diabetes mellitus (6), it has not been demonstrated conclusively that such control holds back the development of diabetic retinopathy (7). Glycosylated hemoglobin have been postulated as a biochemical model for the pathogenesis of diabetic sequelae through the glycosylation reactions (8).…”

Section: Introductionmentioning

confidence: 99%

Study of magnesium, glycosylated hemoglobin and lipid profile in diabetic retinopathy

Kareem

Jaweed

Bardapurkar

et al. 2004

Indian J Clin Biochem

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The present study was undertaken in 100 subjects, 30 diabetics without complication (group I), 40 diabetics with retinopathy (group II) and 30 non diabetic as normal control group (group III). Blood sugar levels, magnesium, cholesterol and triglyceride were analyzed from plasma and serum. The results were correlated with degree of diabetic control from the levels of glycosylated hemoglobin. Serum magnesium levels in group II were found to be significantly lowered than in group I. There was also significant difference in magnesium levels of group I and group III. We found a significant correlation between the glycosylated hemoglobin and magnesium levels in our study.The results also indicate that the patients with diabetic retinopathy showed significant rise in serum cholesterol and triglyceride. Probably hypomagnesemia and increased serum cholesterol and triglyceride levels are responsible for microvascular changes in diabetes leading to retinopathy. The purpose of this study was thus to gather information about the degree of control of diabetes and magnesium status.

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“…However several data strongly suggest that the mechanisms responsible for diabetic microangiopathy are initiated as a result of insulin deficiency and that the development of the microvascular complications of diabetes may be inhibited and/or delayed by careful control of blood glucose concentration. Some authors have questionned, however, whether the benefits of tight control are sufficiently proven to warrant the risks of hypoglycaemia [9,10]. They also question whether or not the microangiopathic lesions in diabetic patients could be primarily and completely determined by heredity whatever the carbohydrate tolerance [11].…”

mentioning

confidence: 99%

Relation of diabetic control to development of microvascular complications

Tchobroutsky

1978

Diabetologia

401

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Summary. This review seeks to supply the arguments which support or deny the relationship between the quality of control of blood glucose levels and the course of diabetic microangiopathy. The ideal study is impossible to do in man but most prospective studies suggest that the better the control the slower the rate of progression and severity of lesions. "Scientific" but indirect arguments from biochemical, enzymatic and functional studies have shown that insulin and/or blood glucose control reverse some early diabetic changes that are probably related to the late events. Recent studies suggest that observations on animals that have shown the beneficial effect of treatment are relevant to the problem of diabetic microvascular lesions in man. Heredity influences the development of diabetic microangiopathy in diabetics but retinal and/or glomerular lesions -which are definitely not pathognomonic for diabetes -do not appear in the absence of hyperglycaemia. Muscle capillary basement membrane thickening that seems not to be a specific abnormality was not observed by several investigators in recently diagnosed diabetics. Therefore most of the arguments that have been given to support the point of view that tight control is not justified may be rejected. The opinion of the author is that strict control of diabetes is worthwile in patients with long life expectancy and no psychological, social or cultural handicaps.

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Control of Blood Glucose and Diabetic Vascular Disease

Cited by 157 publications

References 22 publications

The risk of diabetic control: A comparison of hospital versus general practice supervision

The risk of diabetic control: A comparison of hospital versus general practice supervision

Study of magnesium, glycosylated hemoglobin and lipid profile in diabetic retinopathy

Relation of diabetic control to development of microvascular complications

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