Ioverview

There are three general levels of glycemic control that can be set as goals in the management of patients with type 1 or type 2 diabetes: (1) keep patients out of ketoacidosis and hyperosmolar coma; (2) prevent symptoms of hyperglycemia (e.g., polyuria) and catabolism (fatigue, weight loss, and hyperphagia); and (3) prevent long-term complications associated with diabetes. In the absence of extenuating social or medical circumstances that make prevention of long-term complications irrelevant (e.g., terminal illness) or infeasible (e.g., inability of the patient to cooperate with a complex care program), the third level should be the standard of care for people with diabetes. The effectiveness of good glycemic control in slowing or preventing the development of diabetic retinopathy, ne-phropathy, and neuropathy has been demonstrated in several well-controlled clinical trials and is beyond question. Whether good glycemic control has a beneficial effect on the risk of atherosclerosis and its clinical manifestations remains controversial. In this chapter, we will illustrate that improved glycemic control is beneficial for reducing the risk of clinical atherosclerotic events, but that methods of ^

g achieving good control may differ in their impact on such events.

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Delicious Diabetic Recipes

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