Glucose control in diabetes: which target level to aim for?

Laakso, Markku; Cederberg, Henna

doi:10.1111/j.1365-2796.2012.02528.x

Cited by 21 publications

(15 citation statements)

References 79 publications

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“…The presence of breast cancer and its treatment did not negatively affect metabolic control among patients with DM in this cohort. Only a few had DM therapy advanced to insulin, even though half the cases had HbA1c levels above currently recognized targets of control [17]. The use of steroids in only a minority of patients (only about a quarter of cases and controls) may have limited the impact of breast cancer therapy on hyperglycemia.…”

Section: Discussionmentioning

confidence: 95%

Implications of breast cancer with diabetes mellitus on patient outcomes and care

Karlin¹,

Dueck²,

Reddy³

et al. 2014

Diabetes Management

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Aims: The aim of this study was to determine the impact of diabetes mellitus (DM) on short-term overall survival and time to recurrence (TTR) in breast cancer patients, and examine the impact of breast cancer on glycemic control in DM. Methods: From a data set of newly diagnosed breast cancer patients (2007)(2008)(2009)(2010)(2011), we identified 109 patients with DM and 109 matched controls. Results: Hemoglobin A1c among cases did not significantly change over 1 year (p = 0.10). Cases and controls showed no differences in OS (hazard ratio: 1.25; 95% CI: 0.49-3.17) during the median follow-up of 2.2 years (range: 0.1-4.9 years) and no differences in TTR (hazard ratio: 1.00; 95% CI: 0.14-7.10). Conclusion: DM did not adversely affect metabolic control, short-term OS or TTR. KEYWORDSCoexisting diabetes mellitus (DM) and cancer has been a topic of increasing interest [1]. DM is associated with an increased risk of development of many types of cancers [2][3][4]. Moreover, several studies have indicated that coexisting DM is associated with greater mortality in several types of cancers, including colorectal, endometrial, pancreas, liver and bladder [5,6]. A relationship between hyperglycemia and cancer mortality has also been noted [7,8].The link between DM and breast cancer is of particular interest, given the common risk factors of obesity, diet and hyperinsulinemia [2][3][4]. Current hypotheses regarding mechanisms of the link between DM and breast cancer can be found in two recent reviews [2,5]. Postulated Practice points• The link between diabetes mellitus (DM) and breast cancer is of particular interest, given the common risk factors of obesity, diet and hyperinsulinemia.• Previous studies typically have not examined how DM might affect breast cancer mortality or how breast cancer might alter outcomes of patients with DM in a single analysis.• The purpose of this study was to examine whether breast cancer and its treatment affected glycemic control and therapy for DM and to assess its impact on short-term overall survival and time to recurrence.• The presence of breast cancer and its treatment did not negatively affect metabolic control among patients with DM in this cohort.• DM did not appear to affect either breast cancer overall survival or time to recurrence in the short term.For reprint orders, please contact: reprints@futuremedicine.com

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Section: Discussionmentioning

confidence: 95%

Implications of breast cancer with diabetes mellitus on patient outcomes and care

Karlin¹,

Dueck²,

Reddy³

et al. 2014

Diabetes Management

View full text Add to dashboard Cite

show abstract

“…Higher values are a sign of insufficient blood glucose control and poor metabolic control 14. An HbA1C target of <7.0% for the treatment of diabetes is generally accepted to lower the risk of long-term micro or macrovascular diabetes complications 15. For this reason, patients with type 2 DM were divided into two groups according to their HbA1C blood levels.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the relationship between corneal biomechanic and HbA1C levels in type 2 diabetes patients

Yazgan¹,

Çelik²,

Kaldırım³

et al. 2014

OPTH

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PurposeTo evaluate the corneal biomechanical properties due to the glycosylated hemoglobin (HbA1C) levels using the ocular response analyzer (ORA) in the patients with type 2 diabetes mellitus (DM).MethodsORA values were obtained from 156 eyes of subjects with type 2 DM and 74 eyes of healthy control subjects with similar age and sex. Subjects were divided into three groups: Group 1, healthy control subjects; Group 2, diabetes patients with HbA1C <7%; and Group 3, diabetes patients with HbA1C ≥7%. Corneal biomechanical parameters: corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) measurements were obtained using ORA. Ultrasound pachymetry was used for measurement of central corneal thickness (CCT).ResultsCH and CRF were significantly different in each of the three groups (P-values for CH respectively; Groups 1 and 2=0.008, Groups 1 and 3, and Groups 2 and 3, <0.001, and for CRF respectively; =0.002, <0.001, <0.001). CCT was significantly different between Groups 1 and 3 and Groups 2 and 3 (P<0.001) but was insignificant between Groups 1 and 2 (P=0.965). IOPcc was not different between Groups 1 and 2 (P=0.524), and Groups 2 and 3 (P=0.115), but was significantly different between Groups 1 and 3 (P=0.003). IOPg was statistically different between each of the three groups (respectively; Groups 1 and 2, P=0.015, Groups 1 and 3, and Groups 2 and 3, P<0.001).ConclusionBoth diabetes groups were affected in terms of corneal biomechanical properties when compared to healthy subjects, there was also a positive correlation between HbA1C level and intraocular pressure.

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“…There is still controversy as to how strict glycemic control should be to avoid severe complications (14,15). In clinical practice, it is of great importance to find the right balance between the risk for severe microvascular complications, potentially dangerous hypoglycemic events, and quality of life and to be able to recommend an optimal level of HbA 1c both in the short and long term.…”

mentioning

confidence: 99%

Impact of HbA1c, Followed From Onset of Type 1 Diabetes, on the Development of Severe Retinopathy and Nephropathy: The VISS Study (Vascular Diabetic Complications in Southeast Sweden)

et al. 2014

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OBJECTIVEHbA 1c is strongly related to the development of diabetes complications, but it is still controversial which HbA 1c level to strive for in the treatment of type 1 diabetes. The aim of the current study was to evaluate HbA 1c , followed from diagnosis, as a predictor of severe microvascular complications and to formulate HbA 1c target levels for treatment. RESEARCH DESIGN AND METHODSA longitudinal observation study followed an unselected population of 451 patients diagnosed with type 1 diabetes during 1983-1987 before the age of 35 years in a region of Southeast Sweden. Retinopathy was evaluated by fundus photography and nephropathy data collected from medical records. HbA 1c was measured starting from diagnosis and during the whole follow-up period of 20-24 years. Long-term weighted mean HbA 1c was then calculated. Complications were analyzed in relation to HbA 1c levels. RESULTSThe incidence of proliferative retinopathy and persistent macroalbuminuria increased sharply and occurred earlier with increasing long-term mean HbA 1c . None of the 451 patients developed proliferative retinopathy or persistent macroalbuminuria below long-term weighted mean HbA 1c 7.6% (60 mmol/mol); 51% of the patients with long-term mean HbA 1c above 9.5% (80 mmol/mol) developed proliferative retinopathy and 23% persistent macroalbuminuria. CONCLUSIONSLong-term weighted mean HbA 1c , measured from diagnosis, is closely associated with the development of severe complications in type 1 diabetes. Keeping HbA 1c below 7.6% (60 mmol/mol) as a treatment target seems to prevent proliferative retinopathy and persistent macroalbuminuria for up to 20 years.

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Glucose control in diabetes: which target level to aim for?

Cited by 21 publications

References 79 publications

Implications of breast cancer with diabetes mellitus on patient outcomes and care

Implications of breast cancer with diabetes mellitus on patient outcomes and care

Evaluation of the relationship between corneal biomechanic and HbA1C levels in type 2 diabetes patients

Impact of HbA1c, Followed From Onset of Type 1 Diabetes, on the Development of Severe Retinopathy and Nephropathy: The VISS Study (Vascular Diabetic Complications in Southeast Sweden)

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