Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus

Abstract

Background Clinical guidelines differ regarding their recommended blood glucose targets for patients with type 1 diabetes and recent studies on patients with type 2 diabetes suggest that aiming at very low targets can increase the risk of mortality. Objectives To assess the effects of intensive versus conventional glycaemic targets in patients with type 1 diabetes in terms of long-term complications and determine whether very low, near normoglycaemic values are of additional benefit. Search methods A systematic literature search was performed in the databases The Cochrane Library, MEDLINE and EMBASE. The date of the last search was December 2012 for all databases. Selection criteria We included all randomised controlled trials (RCTs) that had defined different glycaemic targets in the treatment arms, studied patients with type 1 diabetes, and had a follow-up duration of at least one year. Data collection and analysis Two review authors independently extracted data, assessed studies for risk of bias, with differences resolved by consensus. Overall study quality was evaluated by the 'Grading of Recommendations Assessment, Development, and Evaluation' (GRADE) system. Randomeffects models were used for the main analyses and the results are presented as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes.

Effects of exogenous human insulin dose adjustment on body mass index in adult patients with type 1 diabetes mellitus at Kalafong Hospital, Pretoria, South Africa, 2009 - 2014

“…Furthermore, the choice of regimen depended on the individual needs and circumstances of the patient, as well as the treating health professional's judgement. [8] This assertion was consistent with that of Fullerton et al [9] that there was then (in 2014) no firm evidence for specific blood glucose targets, therefore necessitating individualised therapeutic goals that take into account the patient's age, disease progression, macrovascular risk, lifestyle and disease self-management capabilities. The reviewers also concluded that patient-specific regimens to optimise glycaemic control have been made possible by the development of insulin analogues, which increase flexibility and control in the treatment of type 1 DM.…”

“…[9] These therapy-related issues [8,9] were found to be adequately addressed in the Kalafong Diabetes Clinic practice.…”

“…These issues include lifestyle adjustments and exercise, meal intake and its effects, proper insulin self-administration, and the effects of insulin dose adjustments not based on reliable blood glucose readings. [9] These therapy-related issues [8,9] were found to be adequately addressed in the Kalafong Diabetes Clinic practice.…”

“…Also, because IIT with basal NPH and prandial human insulin requires multiple daily injections, it was crucial that health workers communicate therapy-related issues to patients. These issues include lifestyle adjustments and exercise, meal intake and its effects, proper insulin self-administration, and the effects of insulin dose adjustments not based on reliable blood glucose readings.[9] These therapy-related issues [8,9] were found to be adequately addressed in the Kalafong Diabetes Clinic practice.The current study concluded that exposure to adjusted doses of human insulin to achieve optimal glycaemic control in patients with type 1 DM resulted in a statistically significant increase in BMI. This relationship seemed to be more prominent in female patients and in patients with higher baseline HbA1c levels and BMI categories.…”

Overview of Diabetes Mellitus and its Treatment

“…These types are reviewed briefly in the coming section. [3] From 2012-2015, approximately 1.5 to 5.0 million of people died because of diabetes disease. When compared to other incurable diseases, death rate is high in the case of diabetes (i.e) nearly one person die in every 10 seconds.…”