The Effect of Long-term Intensified Insulin Treatment on the Development of Microvascular Complications of Diabetes Mellitus

Predictors of mortality in insulin dependent diabetes: 10 year observational follow up study

“…However, as reviewed by Parving et al, microalbuminuria is associated with many cardiovascular risk factors, such as raised arterial blood pressure, poor glycaemic control, dyslipoproteinaemia, increased platelet aggre-gability, endothelial dysfunction, autonomic nervous dysfunction, and left ventricular hypertrophy 24. Several but not all studies have shown that strict metabolic control25 26 27 28 and treatment with angiotensin converting enzyme inhibitors29 30 can delay the progression from microalbuminuria to overt diabetic nephropathy. Our study was conducted before a general attempt to improve metabolic control in a large clinic was initiated (mean haemoglobin A 1c concentration at the end of follow up 8.8% (SD 1.5%)) and only 16% of our microalbuminuric insulin dependent diabetic patients were treated with angiotensin converting enzyme inhibitors at the end of follow up.…”

Targets for glycated haemoglobin

“…More importantly, even before the results of the diabetes control and complications trial were available it was evident that the relation between glycated haemoglobin and microvascular complications steepened considerably at a haemoglobin A1c concentration of around 7.5% 6 7. With this assay (normal concentration <6.1%) 65% of people with non-insulin dependent diabetes and 39% of those with insulin dependent diabetes achieve satisfactory blood glucose control (good plus borderline control) in our service.…”

Prevention of Hypoglycemia While Achieving Good Glycemic Control in Type 1 Diabetes

“…In the Diabetes Control and Complications Trial, the frequency of severe hypoglycemia increased threefold in diabetic subjects treated with intensive insulin therapy compared with subjects on conventional therapy (ϳ0.6 vs. ϳ0.2 episodes/patient-year) (1). Similarly, in the Stockholm Diabetes Intervention Study, severe hypoglycemia was 2.5 times greater in the intensively treated patients (2). In type 2 diabetes, the rates of severe hypoglycemia are lower than in type 1 diabetes.…”

“…nsulin therapy in diabetes, both at onset and after several years' duration, is primarily directed to maintain nearnormoglycemia to prevent the onset and/or delay progression of long-term complications (1,2). However, it is important that regimens of insulin therapy are designed not only to aim at nearnormalizing blood glucose, but also to minimize the risk of hypoglycemia.…”