The Effects of Improved Glycemic Control on Complications in Type 2 Diabetes

Abstract

Type 2 diabetes is 8 to 10 times more common than type 1 diabetes, but no single large trial has established that improved glycemic control can prevent complications in type 2 diabetes. We have reviewed the results of the existing epidemiologic and clinical trial studies and have arrived at the following conclusions: (1) Strong evidence exists that improved glycemic control is effective at lessening the risks of retinopathy, neuropathy, and nephropathy in type 2 diabetes. (2) The evidence about the effect on coronary heart disease is limited and equivocal. (3) The hypoglycemic risk from improved glycemic control is significantly less in type 2 diabetes than in type 1, and weight gain seems to be modest. In conclusion, although glycemic goals should be individualized based on several clinical factors, most patients with type 2 diabetes would probably benefit from glucose lowering to a hemoglobin A1c level between 7% and 8%.

Factors Associated with Poor Glycemic Control among Patients with Type 2 Diabetes Mellitus in Ambo Hospital, Ambo; Ethiopia

“…In clinical practice, optimal glycemic control is difficult to obtain on a long-term basis because the reasons for poor glycemic control in T2DM are complex [5] Both patient and health care provider-related factors may contribute to poor glycemic control [6,7]. The American Diabetes Association (ADA) has designated HbA1c level of <7% as a goal of optimal blood glucose control [8] and the American Association of Clinical Endocrinologist has further recommended HbA1c level of < 6.5% [9].…”

Effect of two antihypertensive combinations on metabolic control in type-2 diabetic hypertensive patients with albuminuria: a randomised, double-blind study

“…20,21 In the UKPDS, 22 a difference of 0.9% in HbA1c was associated with a risk reduction of 36% for all-cause mortality (9-55, P ϭ 0.011) and with a 42% for diabetes-related death (9-63, P ϭ 0.017). In a very recent cohort study, in 4662 men followed for 2 to 4 years, an increase of 1% in HbA1c was associated with 28% (P Ͻ 0.002) increase in risk of death independent of age, blood pressure, serum cholesterol, body mass index and cigarette smoking habit.…”

Cross-talk between angiotensin II and glucagon receptor signaling mediates phosphorylation of mitogen-activated protein kinases ERK 1/2 in rat glomerular mesangial cells

“…Diabetes mellitus is a major risk factor for the development of cardiovascular and renal target organ damage, leading to hypertension, atherosclerosis, ischemic heart disease and diabetic nephropathy [1,2]. Types 1 and 2 diabetes mellitus together affect more than 20 million Americans and rank as the sixth leading cause of disease-related death in the US.…”

“…Type 1 diabetes is due to insulin deficiency, and therefore requires treatment with insulin or transplantation of pancreatic β cells [3]. By contrast, the majority of the diabetic population has type 2 diabetes, which is not insulin-dependent and in most case does not require insulin therapy [1,2]. Type 2 diabetes is characterized by persistent hyperglycemia, impaired glucose tolerance, glomerular hyperfiltration, and progression of albuminuria, ultimately leading to renal injury [1,2].…”

“…By contrast, the majority of the diabetic population has type 2 diabetes, which is not insulin-dependent and in most case does not require insulin therapy [1,2]. Type 2 diabetes is characterized by persistent hyperglycemia, impaired glucose tolerance, glomerular hyperfiltration, and progression of albuminuria, ultimately leading to renal injury [1,2]. Although increased insulin resistance rather than insulin deficiency plays a key role in the development of type 2 diabetes [1], the factors that contribute to increased insulin resistance remain incompletely understood.…”