Historical HbA1c Values May Explain the Type 2 Diabetes Legacy Effect: UKPDS 88

Lind, Marcus; Imberg, Henrik; Coleman, Ruth L.; Nerman, Olle; Holman, Rury R.

doi:10.2337/dc20-2439

Cited by 73 publications

(46 citation statements)

References 35 publications

(72 reference statements)

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“…Attaining recommended glycaemic targets yields substantial and enduring reductions in the onset and progression of microvascular complications [ 11 , 12 ] and early intervention is essential [ 13 ]. The greatest absolute risk reduction comes from improving very elevated glycaemic levels, and a more modest reduction results from near normalisation of plasma glucose levels [ 2 , 14 ].…”

Section: The Rationale Importance and Context Of Glucose-lowering Tre...mentioning

confidence: 99%

Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

et al. 2022

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The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the previous consensus statements on the management of hyperglycaemia in type 2 diabetes in adults, published since 2006 and last updated in 2019. The target audience is the full spectrum of the professional healthcare team providing diabetes care in the USA and Europe. A systematic examination of publications since 2018 informed new recommendations. These include additional focus on social determinants of health, the healthcare system and physical activity behaviours including sleep. There is a greater emphasis on weight management as part of the holistic approach to diabetes management. The results of cardiovascular and kidney outcomes trials involving sodium–glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, including assessment of subgroups, inform broader recommendations for cardiorenal protection in people with diabetes at high risk of cardiorenal disease. After a summary listing of consensus recommendations, practical tips for implementation are provided. Graphical abstract Supplementary Information The online version of this article (10.1007/s00125-022-05787-2) contains peer-reviewed but unedited supplementary material.

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Section: The Rationale Importance and Context Of Glucose-lowering Tre...mentioning

confidence: 99%

Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

et al. 2022

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“…Thirdly, our findings add weight to the importance of early and strict metabolic control in T2DM. Two post hoc analyses of the UKPDS study have shown that the glycemic legacy effects seen in T2DM are largely explained by historical HbA1c values, which have a greater impact on renal and cardiovascular outcomes than recent values; microvascular complications and mortality also increased in those patients who presented HbA1c >6.5% in the first year after diagnosis [ 21 , 22 ]. Based on our findings and supported by these post hoc studies, we could suggest that early detection of diabetes and intensive glucose control from the time of diagnosis are essential for maximum reduction of long-term risk of glycemic complications.…”

Section: Discussionmentioning

confidence: 99%

Renal Histologic Findings in Necropsies of Type 2 Diabetes Mellitus Patients

D’Marco

Puchades

Escudero-Saiz

et al. 2022

Journal of Diabetes Research

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Background. Very few studies have analyzed early histologic lesions of diabetic nephropathy (DN) in patients without signs of clinical involvement (microalbuminuria). In this study, we analyzed renal histologic lesions in necropsies of diabetic patients with or without previous signs of DN. Methods. Histological material was analyzed from 21 autopsies of type 2 diabetes mellitus (T2DM) patients (9 with albuminuria and 12 without albuminuria) and 4 controls. Histologic lesions were evaluated according to the Tervaert classification. Results. Kidneys of diabetic patients presented significantly higher scores in most histologic indices analyzed (glomerular basal membrane thickening, mild and severe mesangial expansion, nodular sclerosis, interstitial fibrosis, and tubular atrophy) than in nondiabetic controls ( p < 0.01 in all cases). In contrast, no significant differences were detected between histologic scores when comparing the 21 diabetic patients with and without albuminuria. A significant percentage of cases without albuminuria showed moderate to severe histologic lesions, particularly severe mesangial expansion and severe glomerular vascular lesions. No significant differences were found in age, blood pressure, diabetes vintage, BMI, HbA1c, cholesterol, triglycerides, or treatments between the two (albuminuric vs. nonalbuminuric) T2DM patient groups. Conclusions. Our data suggest that histologic lesions of DN are present in the early stages of the disease, even without albuminuria presence. More precise and earlier metabolic control is recommended in T2DM, and monitoring of risk factors can play a role in DN development.

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“…Die Autoren schlussfolgern, dass historische Glukosewerte, vor allem in der Phase der ersten Jahre der Behandlung, die Prognose des Typ-2-Diabetes deutlich stärker beeinflussen als die nachfolgenden bzw. aktuellen Glukosewerte, und fordern eine frühe Diabetesdiagnose und eine möglichst normnahe Glukosekontrolle vor allem zu Beginn der Diabetestherapie [51].…”

Section: Langzeitprognose: Ergebnisse Großer Interventionsstudienunclassified

Körperliche und psychische Folgeerkrankungen bei Diabetes mellitus

Kulzer

2022

Bundesgesundheitsbl

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ZusammenfassungTrotz Verbesserungen in der Therapie des Diabetes und besseren Versorgungbedingungen weisen die Betroffenen aktuell im Vergleich zur Allgemeinbevölkerung noch immer ein deutlich erhöhtes Risiko für physische wie psychische Folgeerkrankungen sowie eine reduzierte Lebensqualität auf. Etwa 21 % aller Todesfälle sind in Deutschland auf Diabetes und seine Folgeerkrankungen zurückzuführen, das Mortalitätsrisiko ist für Menschen mit Diabetes um mehr als das 1,5-Fache gegenüber Menschen ohne Diabetes erhöht. In dieser Übersicht werden die Verbreitung und die Risikofaktoren für die häufigsten körperlichen und psychischen Folgen des Diabetes beschrieben sowie deren Einflüsse auf die Lebensqualität der Patienten. Zusammenhänge zwischen den Folgeerkrankungen und einer erhöhten Mortalität werden aufgezeigt.In großen Interventionsstudien konnte die Bedeutung einer guten Glukoseeinstellung – vor allem zu Beginn der Erkrankung – in Hinblick auf eine Senkung der Mortalitätsrate gezeigt werden, weitere wichtige Einflussfaktoren sind z. B. Blutdruck, Blutfette und Rauchen. Weltweite Studienergebnisse deuten auf einen stabilen Trend hinsichtlich einer verbesserten Lebenserwartung von Menschen mit Diabetes in den letzten Jahren hin. Zukünftig könnte der positive Trend durch bessere Versorgungsstrukturen und neue Technologien sowie digitale Anwendungen in der Forschung und Therapie fortgesetzt werden. Mithilfe der Präzisionsmedizin könnten individuelle Risikofaktoren und protektive Faktoren erkannt werden, um der Entstehung von Folgekomplikationen noch besser vorzubeugen.

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Historical HbA1c Values May Explain the Type 2 Diabetes Legacy Effect: UKPDS 88

Cited by 73 publications

References 35 publications

Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Renal Histologic Findings in Necropsies of Type 2 Diabetes Mellitus Patients

Körperliche und psychische Folgeerkrankungen bei Diabetes mellitus

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