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- May 17, 2008 |
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| Presentation |
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"Targets for Glucose Control: A Review of Recent Evidence"Dr. Gillian Booth (biography)
English - 2003-10-31 - 29 minutes
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 | (44 slides) |
Summary :
The UKPDS and DCCT studies showed the need for good glycemic control in terms of HbA1c, to reduce the risk of microvascular complications (1, 2). However some studies have also looked at the relationship between fasting blood glucose and post prandial glycemia, and the risk of complications. For example, the Kumamoto study looked at FBG (3) and 2-hour postprandial glycemia (4) and risk of retinopathy and nephropathy, and a metaregression analysis done by Coutinho et al looked at the effects FBG and 2-hour PPG on CHD risk (5). More recently Monnier et al described the contribution of PPG to overall hyperglycemia (6).
Intensive therapy to achieve glucose control comes with the risk of hypoglycemia and this will be discussed here, along with the new 2003 CDA blood glucose and HbA1c targets. Finally, the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study is now underway, and is designed to test complementary strategies to reduce CVD outcomes in high-risk type 2 diabetic patients.
Copyright © 2003 E-MedHosting.com Inc
Learning objectives :
The participant will learn about:
- Evidence relating FBG, HbA1c, and postprandial glycemia to complications of DM
- Targets for glycemic control recommended in the 2003 CDA Guidelines
- Recent studies of Intensive therapy – STENO-2
- Upcoming studies of Intensive therapy – ACCORD
Bibliographic references :
1. Stratton IM, Kohner EM, Aldington SJ, Turner RC, Holman RR, Manley SE, Matthews DR. “UKPDS 50: risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis”. Diabetologia. 2001 Feb;44(2):156-63.
2. The Diabetes Control and Complications Trial Research Group: “The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial. (1995).” Diabetes, 44, 968-983.
3. Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, Kojima Y, Furuyoshi N, Shichiri M. “Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study.” Diabetes Res Clin Pract. 1995 May;28(2):103-17.
4.Shichiri M, Kishikawa H, Ohkubo Y, Wake N. Long-term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients. Diabetes Care. 2000 Apr;23 Suppl 2:B21-9.
5. Coutinho M, Gerstein HC, Wang Y, Yusuf S.“The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years.” Diabetes Care. 1999 Feb;22(2):233-40.
6.Louis Monnier, MD, Hélène Lapinski, MD and Claude Colette, PHD. “Contributions of Fasting and Postprandial Plasma Glucose Increments to the Overall Diurnal Hyperglycemia of Type 2 Diabetic Patients.” Diabetes Care 26:881-885, 2003.
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