Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes (VA CSDM): Results of the feasibility trial

Abraira, Carlos; Colwell, John A.; Nuttall, Frank Q.; Sawin, Clark T.; Nagel, Nancy Johnson; Comstock, John P.; Emanuele, Nicholas V.; Levin, Seymour R.; Henderson, William G.; Lee, Hae Sook

doi:10.2337/diacare.18.8.1113

Cited by 344 publications

(236 citation statements)

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“…The low prevalence of severe hypoglycaemia in the UKPDS [2] and other trials [21] may not accurately represent the true frequency in insulin-treated type 2 diabetes. A population-based study found 7% of patients with type 1 and insulin-treated type 2 diabetes had required emergency treatment over 12 months compared with 0.8% of those taking oral agents [5].…”

Section: Discussionmentioning

confidence: 99%

Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration

2007

Diabetologia

763

259

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Aims/hypothesis We explored the epidemiology of hypoglycaemia in individuals with insulin-treated diabetes by testing the hypothesis that diabetes type and duration of insulin treatment influence the risk of hypoglycaemia. Materials and methods This was an observational study over 9-12 months in six UK secondary care diabetes centres. Altogether 383 patients were involved. Patients were divided into the following three treatment groups for type 2 diabetes: (1) sulfonylureas, (2) insulin for <2 years and (3) insulin for >5 years, and into two treatment groups for type 1 diabetes, namely <5 years disease duration and >15 years disease duration. Self-reported (mild and severe) and biochemical episodes (interstitial glucose <2.2 mmol/l using continuous glucose monitoring) were recorded. Results Mild hypoglycaemia in type 2 diabetic patients on insulin for <2 years was less frequent than in type 1 patients with <5 years disease duration (mean rate: 4 vs 36 episodes per subject-year, p<0.001). In type 2 diabetic patients treated with sulfonylureas or insulin for <2 years, no differences were observed in the proportion experiencing severe hypoglycaemia (7 vs 7%, difference 0 [95% CI: −7to 9%]), mild symptomatic (39 vs 51%, difference 12 [−3 to 25%]) or interstitial glucose <2.2 mol/l (22 vs 20%, difference 2 [−13 to 10%]). Severe hypoglycaemia rates were comparable in patients with type 2 diabetes on sulfonylureas or insulin < 2 years (0.1 and 0.2 episodes per subject-year) and far less frequent than in type 1 diabetes (<5 years group, 1.1; >15 years group, 3.2. episodes per subject-year). Conclusions/interpretation During early insulin use in type 2 diabetes, the frequency of hypoglycaemia is generally equivalent to that observed in patients treated with sulfonylureas and considerably lower than during the first 5 years of treatment in type 1 diabetes.

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Section: Discussionmentioning

confidence: 99%

Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration

2007

Diabetologia

763

259

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“…Insulin therapy is also associated with hypoglycaemia, albeit much less frequently than in type 1 diabetes. In clinical trials aimed at normoglycaemia and achieving a mean HbA 1c of~7%, severe hypoglycaemic episodes (defined as requiring help from another person to treat) occurred at a rate of between one and three per 100 patient-years [8, [75][76][77]], compared with 61 per 100 patient-years in the DCCT intensive therapy group [4]. Insulin analogues with longer, non-peaking profiles decrease the risk of hypoglycaemia modestly compared with NPH, and analogues with very short durations of action reduce the risk of hypoglycaemia compared with regular insulin [76,77].…”

Section: Medicationsmentioning

confidence: 99%

Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy

et al. 2008

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The consensus algorithm for the medical management of type 2 diabetes was published in August 2006 with the expectation that it would be updated, based on the availability of new interventions and new evidence to establish their clinical role. The authors continue to endorse the principles used to develop the algorithm and its major features. We are sensitive to the risks of changing the algorithm cavalierly or too frequently, without compelling new information. An update to the consensus algorithm published in January 2008 specifically addressed safety issues surrounding the thiazolidinediones. In this revision, we focus on the new classes of medications that now have more clinical data and experience.

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“…O teste foi logo introduzido na prática clínica para auxiliar no manejo dos pacientes com DM (8). No entanto, foi apenas na década de 90 que o verdadeiro valor clínico desta dosagem laboratorial ficou definitivamente estabelecido, a partir de dois grandes ensaios clínicos (3,4) Esta mesma relação entre níveis de HbA 1c e o desenvolvimento das complicações crônicas do DM também foi observada em outros ensaios clínicos publicados nas últimas décadas (9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Introductionunclassified

Glico-hemoglobina (HbA1c): aspectos clínicos e analíticos

Camargo

Gross

2004

Arq Bras Endocrinol Metab

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RESUMOA glico-hemoglobina (GHb) é um parâmetro importante no controle glicêmico de pacientes com DM. Vários estudos clínicos mostraram claramente que a melhora no controle glicêmico está fortemente associada com a diminuição no desenvolvimento e/ou progressão das complicações em diabetes melito tipos 1 e 2. A medida exata e precisa da GHb é uma questão importante para os laboratórios clínicos. Vários fatores afetam os resultados e podem levar a resultados errôneos. Nesta revisão, discutimos os problemas da padronização da determinação da GHb para monitorar a terapia diabética e também os principais fatores interferentes. Os métodos para GHb podem ser diferentemente afetados pelas interferências. O efeito da interferência pode ser clinicamente mais relevante com o pior controle glicêmico. O laboratório deve estar atento para estes fatores para evitar confusão na interpretação clínica dos resultados, e os clínicos devem contatar o laboratório sempre que houver discrepância entre a impressão clínica e o resultado laboratorial. Glycohemoglobin (GHb) has a key role in the assessment of glycemic control in diabetic patients. Several studies have clearly shown that improved glycemic control is strongly associated with decreased development and/or progression of diabetic complications in both type 1 and 2 diabetes mellitus. Therefore, accurate determination of GHb concentration is an important issue for clinical laboratories. Several factors may affect and lead to erroneous results. We discuss the problems of standardization of GHb measurements for monitoring glycemic control and also consider the potential interfering factors on GHb measurements. Moreover, GHb assays may be affected by interference in different ways. The effect of interference may be more clinically relevant with poor metabolic control. Laboratory staff must be aware of all pitfalls to avoid adding more confusion to the clinical interpretation of HbA 1c values and physicians should contact laboratories if discrepancies between clinical impressions and laboratory data are observed.

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Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes (VA CSDM): Results of the feasibility trial

Cited by 344 publications

References 0 publications

Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration

Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration

Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy

Glico-hemoglobina (HbA1c): aspectos clínicos e analíticos

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