Relation of Diabetic Control to Development of Vascular Complications

Bondy, Philip K.; Felig, Philip

doi:10.1016/s0025-7125(16)32483-x

Cited by 30 publications

(17 citation statements)

References 11 publications

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“…Because of these uncertainities some prominent scientists and physicians have questionned the validity of clinical studies and findings in animals and have asked whether the benefits of tight control have been sufficiently proven to warrant the risks of hypoglycaemia [9,10,23,36]. Eight groups of arguments have been given to support this point of view and these will now be discussed:…”

Section: Discussionmentioning

confidence: 99%

“…Definite criteria are lacking for the quantification of both complications and the degree of control [12]. The ideal study is impossible to do in man for practical and ethical reasons [9,13].…”

Section: Clinical Studiesmentioning

confidence: 99%

“…Numerous large reviews have discussed the relationship between the degree of diabetic control and the develop-0012-186X/78/0015/0143/$02.00 ment of microangiopathy [9,[14][15][16][17][18][19][20][21][22][23]. Some were unable to show a positive effect of the quality of control [9,14,18,23]. In 1964 Knowles [14], after a comprehensive analysis of more than 300 reports, concluded that "information sufficient to arrive at any conclusions is not yet at hand".…”

Section: Clinical Studiesmentioning

confidence: 99%

“…They concluded pessimistically, that a "predominantly statistical approach to therapeutic trial cannot be expected to resolve the existing scientific controversies about treatment". Bondy and Felig wrote that "... this belief must be considered a manifestation of faith rather than of scientifically proven fact" [9]. Raskin's conclusions are "There has been little convincing clinical evidence for the view that rigid control of the metabolic abnormalities will prevent the vascular complications of the disease because few diabetics have ever been rigidly controlled.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…However several data strongly suggest that the mechanisms responsible for diabetic microangiopathy are initiated as a result of insulin deficiency and that the development of the microvascular complications of diabetes may be inhibited and/or delayed by careful control of blood glucose concentration. Some authors have questionned, however, whether the benefits of tight control are sufficiently proven to warrant the risks of hypoglycaemia [9,10]. They also question whether or not the microangiopathic lesions in diabetic patients could be primarily and completely determined by heredity whatever the carbohydrate tolerance [11].…”

mentioning

confidence: 99%

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Relation of diabetic control to development of microvascular complications

Tchobroutsky

1978

Diabetologia

397

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Summary. This review seeks to supply the arguments which support or deny the relationship between the quality of control of blood glucose levels and the course of diabetic microangiopathy. The ideal study is impossible to do in man but most prospective studies suggest that the better the control the slower the rate of progression and severity of lesions. "Scientific" but indirect arguments from biochemical, enzymatic and functional studies have shown that insulin and/or blood glucose control reverse some early diabetic changes that are probably related to the late events. Recent studies suggest that observations on animals that have shown the beneficial effect of treatment are relevant to the problem of diabetic microvascular lesions in man. Heredity influences the development of diabetic microangiopathy in diabetics but retinal and/or glomerular lesions -which are definitely not pathognomonic for diabetes -do not appear in the absence of hyperglycaemia. Muscle capillary basement membrane thickening that seems not to be a specific abnormality was not observed by several investigators in recently diagnosed diabetics. Therefore most of the arguments that have been given to support the point of view that tight control is not justified may be rejected. The opinion of the author is that strict control of diabetes is worthwile in patients with long life expectancy and no psychological, social or cultural handicaps.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Studiesmentioning

confidence: 99%

Section: Clinical Studiesmentioning

confidence: 99%

Section: Clinical Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

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Relation of diabetic control to development of microvascular complications

Tchobroutsky

1978

Diabetologia

397

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Does improved control of glycemia prevent or ameliorate diabetic polyneuropathy?

Dyck

1986

Annals of Neurology

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Fiber loss is primary and multifocal in sural nerves in diabetic polyneuropathy

Dyck

Lais

Karnes

et al. 1986

Annals of Neurology

278

114

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Pathological, morphometric, and teased fiber studies of sural nerve from 36 diabetic patients with (n = 32) and without (n = 4) neuropathy and from 47 healthy subjects provide evidence that in diabetic polyneuropathy: (1) fiber loss is primary; (2) demyelination and remyelination with or without onion bulb formation are secondary; (3) remaining fibers, on average, have the same ratio of small to large fibers as in healthy individuals, but with a greatly increased variability; and (4) the spatial distribution of fiber loss is both diffuse and multifocal. Criteria developed during the study of experimental models of ischemic neuropathy were employed to assess whether ischemic nerve damage had occurred in diabetic polyneuropathy. We conclude that there is increasing evidence that microvascular pathological abnormality and ischemia may be involved in the pathogenesis of human diabetic polyneuropathy. Cases with selective loss of small or large afferent fibers are probably extremes of a normal distribution and not different disorders.

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Relation of Diabetic Control to Development of Vascular Complications

Cited by 30 publications

References 11 publications

Relation of diabetic control to development of microvascular complications

Relation of diabetic control to development of microvascular complications

Does improved control of glycemia prevent or ameliorate diabetic polyneuropathy?

Fiber loss is primary and multifocal in sural nerves in diabetic polyneuropathy

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