| Wednesday, September 17, 2008 |
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Glycemic control and vascular complications in type 2 diabetes mellitus
INTRODUCTION
Morbidity from diabetes is a consequence of both macrovascular disease (atherosclerosis) and microvascular disease (retinopathy, nephropathy, and neuropathy). Prospective, randomized clinical trials such as the Diabetes Control and Complications Trial (DCCT), the United Kingdom Prospective Diabetes Study (UKPDS), and the Kumamoto study have demonstrated that intensive therapy aimed at lower levels of glycemia results in decreased rates of retinopathy, nephropathy, and neuropathy in type 1 and 2 diabetes patients [1-3] .
The importance of tight glycemic control for protection against cardiovascular disease in diabetes has also been established in the DCCT/EDIC study for type 1 diabetes [1] . However, the role of glycemic control in reducing cardiovascular risk has not been established for type 2 diabetes. The effects of glycemic control on microvascular and macrovascular complications in type 2 diabetes will be reviewed here. Glycemic control and vascular complications in type 1 diabetes is discussed separately. (See "Glycemic control and vascular complications in type 1 diabetes mellitus", which also reviews the mechanism by which hyperglycemia might cause these complications). The treatment of diabetes is also discussed elsewhere. (See "Overview of medical care in adults with diabetes mellitus").
HYPERGLYCEMIA AND MICROVASCULAR DISEASE — Hyperglycemia is an important risk factor for the development of microvascular disease in patients with type 2 diabetes, as it is in patients with type 1 diabetes. This has been shown in several observational studies [4-6] . In addition, improving glycemic control improves microvascular outcomes, as illustrated by the following randomized trials:
United Kingdom Prospective Diabetes Study — The UKPDS was designed to compare the efficacy of different treatment regimens (diet, sulfonylurea drug, metformin, and insulin) on glycemic control and the complications of diabetes in about 4000 newly diagnosed patients with type 2 diabetes [2,7] . The target fasting blood glucose concentration was 108 mg/dL (6 mmol/L) or less. Patients in the intensive-therapy group received a sulfonylurea (chlorpropamide, glibenclamide, or glipizide) or insulin; metformin was added to the sulfonylurea if optimal control was not achieved with the latter alone, and insulin was initiated if the combination of oral agents remained ineffective. The conventional-therapy group was treated with diet alone; drugs were added if there were hyperglycemic symptoms or if the fasting blood glucose concentration was greater than 270 mg/dL (15 mmol/L). The following findings were noted: |  |
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- Over 10 years, the average A1C value was 7.0 percent in the intensive-therapy group compared with 7.9 percent in the conventional-therapy group (11 percent reduction) (show figure 1).
- The risk for any diabetes-related end point (see abstract for definition of endpoints [2] ) was 12 percent lower in the intensive-therapy group (P = 0.029) and 10 percent lower for any diabetes-related death (P = 0.34) (show figure 2). It was estimated that 19.6 patients would have to be treated to prevent any single end point in one patient in 10 years.
- Most of the risk reduction in the intensive therapy group was due to a 25 percent risk reduction in microvascular disease (P = 0.001) (show figure 3); there was no reduction in macrovascular disease. (See "Macrovascular disease" below, section on UKPDS).
- The benefits of intensive therapy appeared to be independent of the type of treatment administered.
- Patients in the intensive therapy group had more hypoglycemic episodes and weight gain; weight gain was greater in those receiving insulin (4.0 kg) than in those receiving chlorpropamide (2.6 kg) or glibenclamide (1.7 kg).
The reduction in microvascular complications in patients receiving intensive therapy was of a smaller magnitude than in patients with type 1 diabetes in the DCCT [1] . In the DCCT, for example, the incidence of new retinopathy was 12 percent with intensive therapy versus 54 percent with conventional therapy. One possible explanation for this difference is that the difference in A1C values was smaller between the intensive and conventional therapy groups in the UKPDS (7.0 versus 7.9 percent) compared to the DCCT (7.2 versus 9.1 percent). |
posted by ummu Fauzan @ 9:00 AM   |
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| 10 Comments: |
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a very good discussion, I liked your discussion, continue to develop the science of nursing, I like your posts, thanks
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Diabetes mellitus, often simply referred to as diabetes—is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).
There are three main types of diabetes:
Type 1 diabetes: results from the body's failure to produce insulin, and presently requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.)
Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. (Formerly referred to as non-insulin-dependent diabetes mellitus, NIDDM for short, and adult-onset diabetes.)
Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.
Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.
So simply diabetes mellitus is the specific medical name for all three main Diabetes type 1 , Diabetes type 2, Diabetes gestational (pregnancy related) and other forms that are listed above.
For Diabetes Medicine details, check out the Source link Below.
Diabetes Medicine
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I would like to know if there are any differences in the symptoms and complications related to type 1 and type 2 diabetes mellitus. Like, are there symptoms specific to type 1 or specific to type 2 ? Or are symptoms/complications of the two types more or less the same??? Thank you for your response.
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Hi,
I hope all is well with you. Healthline just published an overview of a ConsumerReports’ evaluation of treatments and medications for Type II Diabetes. This is highly valuable information as it provides diabetes patients with an understanding of which medication is right for them.
You can see the overview of the report here: http://www.healthline.com/health/consumer-reports-type-2-diabetes
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Happy Wednesday! Bloghoppin' here... Hey, I have an interesting tutorial for you that I have written myself. It is about adding Adsense on your Single Post in XML template. I hope you'll like it! God Bless you!