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Intensive glucose therapy and clinical implications of recent data: a consensus statement from the Global Task Force on Glycaemic Control

Akalin, S.; Berntorp, Kerstin LU ; Ceriello, A.; Das, A. K.; Kilpatrick, E. S.; Koblik, T.; Munichoodappa, C. S.; Pan, C. Y.; Rosenthall, W. and Shestakova, M., et al. (2009) In International Journal of Clinical Practice 63(10). p.1421-1425
Abstract
Background: There is compelling evidence showing that achieving good glycaemic control reduces the risk of microvascular complications in people with type 1 and type 2 diabetes. Likewise, there is clear evidence to show that achieving good glycaemic control reduces the risk of macrovascular complications in type 1 diabetes. The UKPDS 10-year follow up suggests that good glycaemic control also reduces the risk of macrovascular complications in type 2 diabetes. Despite this, recent results from ACCORD, ADVANCE and VADT present conflicting results and data from the ACCORD trial appear to suggest that very low HbA(1c) targets (< 6.0%) may, in fact, be dangerous in certain patient populations. Aim: To review recent results from ACCORD,... (More)
Background: There is compelling evidence showing that achieving good glycaemic control reduces the risk of microvascular complications in people with type 1 and type 2 diabetes. Likewise, there is clear evidence to show that achieving good glycaemic control reduces the risk of macrovascular complications in type 1 diabetes. The UKPDS 10-year follow up suggests that good glycaemic control also reduces the risk of macrovascular complications in type 2 diabetes. Despite this, recent results from ACCORD, ADVANCE and VADT present conflicting results and data from the ACCORD trial appear to suggest that very low HbA(1c) targets (< 6.0%) may, in fact, be dangerous in certain patient populations. Aim: To review recent results from ACCORD, ADVANCE and VADT and provide clear guidance on the clinical significance of the new data and their implications for the practising physician treating patients with type 2 diabetes. Methods: A Pubmed search was used to identify major randomised clinical trials examining the association between glycaemic control and diabetes-associated complications. The data was reviewed and discussed by the GTF through a consensus meeting. The recommendations for clinical practice in this statement are the conclusions of these analyses and discussions. Results: Evidence from ACCORD, ADVANCE, VADT and UKPDS suggests that certain patient populations, such as those with moderate diabetes duration and/or no pre-existing CVD, may benefit from intensive blood glucose control. These trials highlight the benefit of a multifactorial treatment approach to diabetes. However, ACCORD results indicate that aggressive HbA(1c) targets (< 6.0%) may not be beneficial in patients with existing CVD and a longer duration of diabetes. Conclusions: Glycaemic control remains a very important component of treatment for type 2 diabetes and contrasting results from the ACCORD, ADVANCE and VADT should not discourage physicians from controlling blood glucose levels. (Less)
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Contribution to journal
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published
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in
International Journal of Clinical Practice
volume
63
issue
10
pages
1421 - 1425
publisher
Wiley-Blackwell
external identifiers
  • wos:000269805800007
  • scopus:70349237376
ISSN
1742-1241
DOI
10.1111/j.1742-1241.2009.02165.x
language
English
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yes
id
5a01efb2-a9c6-4c13-b667-d2b6d36c5c75 (old id 1492333)
date added to LUP
2009-10-16 16:23:19
date last changed
2017-09-24 03:53:23
@article{5a01efb2-a9c6-4c13-b667-d2b6d36c5c75,
  abstract     = {Background: There is compelling evidence showing that achieving good glycaemic control reduces the risk of microvascular complications in people with type 1 and type 2 diabetes. Likewise, there is clear evidence to show that achieving good glycaemic control reduces the risk of macrovascular complications in type 1 diabetes. The UKPDS 10-year follow up suggests that good glycaemic control also reduces the risk of macrovascular complications in type 2 diabetes. Despite this, recent results from ACCORD, ADVANCE and VADT present conflicting results and data from the ACCORD trial appear to suggest that very low HbA(1c) targets (&lt; 6.0%) may, in fact, be dangerous in certain patient populations. Aim: To review recent results from ACCORD, ADVANCE and VADT and provide clear guidance on the clinical significance of the new data and their implications for the practising physician treating patients with type 2 diabetes. Methods: A Pubmed search was used to identify major randomised clinical trials examining the association between glycaemic control and diabetes-associated complications. The data was reviewed and discussed by the GTF through a consensus meeting. The recommendations for clinical practice in this statement are the conclusions of these analyses and discussions. Results: Evidence from ACCORD, ADVANCE, VADT and UKPDS suggests that certain patient populations, such as those with moderate diabetes duration and/or no pre-existing CVD, may benefit from intensive blood glucose control. These trials highlight the benefit of a multifactorial treatment approach to diabetes. However, ACCORD results indicate that aggressive HbA(1c) targets (&lt; 6.0%) may not be beneficial in patients with existing CVD and a longer duration of diabetes. Conclusions: Glycaemic control remains a very important component of treatment for type 2 diabetes and contrasting results from the ACCORD, ADVANCE and VADT should not discourage physicians from controlling blood glucose levels.},
  author       = {Akalin, S. and Berntorp, Kerstin and Ceriello, A. and Das, A. K. and Kilpatrick, E. S. and Koblik, T. and Munichoodappa, C. S. and Pan, C. Y. and Rosenthall, W. and Shestakova, M. and Wolnik, B. and Woo, V. and Yang, W. Y. and Yilmaz, M. T.},
  issn         = {1742-1241},
  language     = {eng},
  number       = {10},
  pages        = {1421--1425},
  publisher    = {Wiley-Blackwell},
  series       = {International Journal of Clinical Practice},
  title        = {Intensive glucose therapy and clinical implications of recent data: a consensus statement from the Global Task Force on Glycaemic Control},
  url          = {http://dx.doi.org/10.1111/j.1742-1241.2009.02165.x},
  volume       = {63},
  year         = {2009},
}