Glycaemic control in diabetes

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William H Herman, associate professor of medicine (wherman@umich.edu) on behalf of Clinical Evidence

Division of Endocrinology and Metabolism, University of Michigan Medical Center, Ann Arbor, MI 48109-0354, USA

This review is one of over 60 chapters included in the first issue of Clinical Evidence, a new information resource for clinicians available from 28 June 1999. The compendium will be updated and expanded every six months. Future issues of Clinical Evidence will summarise the relevant results of the UK prospective diabetes study.

Key messages

We found strong evidence that intensive compared with conventional treatment reduces the development and progression of microvascular and neuropathic complications in both type 1 and type 2 diabetes
RCTs have found that intensive treatment causes hypoglycaemia and weight gain without adverse impact on neuropsychological function or quality of life
We found no evidence that intensive treatment reduces adverse cardiovascular outcomes
Large RCTs have found that diabetic complications increase with HbA1c concentrations above the non-diabetic range

www.evidence.org

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Background

Definition: Diabetes mellitus is a group of metabolic diseases characterised by hyperglycaemia (fasting plasma glucose ≥7.0 mmol/l, or two hour post 75g oral glucose load plasma glucose ≥11.1 mmol/l, on two or more occasions). Intensive treatment is designed to achieve blood glucose values as close to the non-diabetic range as possible. The essential components of such treatment are education, counselling, monitoring, self management, and pharmacological treatment with insulin or oral antidiabetic agents, to achieve specific glycaemic goals.

Incidence/prevalence: Diabetes is diagnosed in around 5% of adults aged 20 years or over in the United States.1 A further 2.7% have undiagnosed diabetes on the basis of fasting glucose. The prevalence is similar in men and women, but diabetes is more common in many ethnic groups. The prevalence in people aged 40-74 has increased over the past decade.

Aetiology: Diabetes results from deficient insulin secretion, decreased insulin action, or both. Many processes can be involved, ranging from autoimmune destruction of the β cells of the …