Achieving glycemic control: cornerstone in the treatment of patients with multiple metabolic risk factors.J Am Osteopath Assoc. 2009 May; 109(5 Suppl):S8-S13.JA
The control of glycosylated hemoglobin (HbA(1c)) levels is crucial to the successful treatment of patients with diabetes mellitus (T2DM). Glycemic control is a cornerstone for reducing end-organ disease, and HbA(1c) is the benchmark for defining glucose control over long durations. The author reviews available information from published clinical trials regarding the benefits of tight glycemic control in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). He notes that published data support the use of tight glucose control for reducing risks of retinopathy, nephropathy, and neuropathy in both patients with T1DM and patients with T2DM. He also notes that early aggressive insulin management of younger individuals with T1DM led to reductions in the incidence of myocardial infarction (MI), stroke, and death. However, published data do not clearly support benefits of tight glucose control for the prevention of cardiovascular events in older patients with long-standing T2DM. The author also reviews recommended treatments for achieving and maintaining glycemic control in patients. He concludes that the most successful treatment requires that physicians encourage patients to actively participate in the management of their own disease, and that physicians provide patients with opportunities to learn the cornerstones of effective therapy.