1 / 7

Glycemic Control in Type 2 Diabetes: How Tight is Too Tight?

This article addresses the controversy surrounding glycemic control in type 2 diabetes and provides a framework for decision-making. It compares and contrasts recent trial results to determine the optimal target for A1c levels. The article also discusses the relationship between hyperglycemia and microvascular and macrovascular diseases and highlights the non-vascular risks associated with hyperglycemia. The potential benefits and risks of various treatment options are also explored.

natashal
Download Presentation

Glycemic Control in Type 2 Diabetes: How Tight is Too Tight?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Glycemic Control in Type 2 Diabetes: How Tight is Too Tight? Frederick L. Brancati, MD, MHS Professor of Medicine & Epidemiology Director, Division of General Internal Medicine Visit Hopkins GIM at www.hopkinsmedicine.org/gim NCH Healthcare System, Naples, FL 21 January 2010

  2. Objectives • Identify controversy in diabetes care • Establish framework for decision-making • Compare/contrast results from recent trials

  3. Why Treat A1c to 7% Target ? • Hyperglycemia predicts micro & macrovascular disease epidemiologically • The link with micro & macrovascular disease is biologically plausible • Hyperglycemia poses non-vascular risks • Infection, Hypovolemia, Urinary Frequency • Improved glycemic control reduces risk of microvascular disease

  4. Why Treat A1c to 7% Target ? • Improved glycemic control reduces CVD in • Type 1 diabetes (DCCT) • Recently diagnosed type 2 diabetes (UKPDS) • Black box warnings require context • Lactic acidosis with metformin is very rare • CHF with TZDs is relatively mild/reversible • Black box MI warning for rosiglitazone only

  5. Cumulative Risk of Infectious Disease Death by Diabetes Status in US Adults, NHANESII Mortality Study AG Bertoni et al. Diabetes Care 2001 24:1044-9.

  6. Age, Sex, Race-Adjusted Relative Hazard of CHD by HbA1c in 1321 Adults without Diabetes (A) and 1626 Adults with Diabetes (B) Selvin, E. et al. Arch Intern Med 2005;165:1910-1916.

  7. Cumulative Incidence of First Episode of Falling in 139 Elderly Nursing Home Residents by Diabetes Status In multivariate analysis, only diabetes (adjusted hazard ratio 4.03; 95% confidence interval, 1.96–8.28) and gait and balance (adjusted hazard ratio 5.26; 95% confidence interval, 1.26–22.02) were significantly and independently associated with an increased risk of falls. MS Maurer et al. J Gerontol A Biol Sci Med Sci (2005) 60:1157–62

More Related