Control of Hyperglycemia

Several studies demonstrate the importance of intensive glycemic control in preventing or reducing microvascular complications of DM. The effect of intensive glycemic control on macrovascular complications in type 1 and type 2 DM is not as convincing. The Diabetes Control and Complications Trial (DCCT) demonstrated compelling evidence in support of a major reduction in chronic micro-vascular complications among type 1 diabetics under tight glycemic control. In the same study, tight glycemic control was associated with a reduction in major macrovascular events by approximately 50% compared with that in those in whom glycemic control was conventional or less stringent. This difference did not achieve statistical significance. Similarly, the United Kingdom Prospective Diabetes Study (UKPDS) has shown that during 10 years of follow-up intensive glycemic control with either insulin or sulfonylureas decreased the risk of micro-vascular complications by 25% in non-insulin-requiring diabetics. The incidence of MI and diabetes-related mortality was reduced by 20% and 10%, respectively. Again, these differences did not achieve statistical significance. A similar reduction was observed in obese non-insulin-requiring diabetics who received metfor-min. In addition, a recent small-scale study showed that tight glycemic control in diabetic subjects reduced major cardiac adverse events (MACE) following balloon PCI. In the aggregate, these results support aggressive management of hyperglycemia in diabetics, especially in those who are candidates for coronary revascularization.

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