Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
Objectives Poorly controlled type 2 diabetes mellitus ( T2DM ) is a major international health problem .
Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials
Diabetes is defined by its association with hyperglycemia-specific microvascular complications ; however , it also imparts a two- to fourfold risk of cardiovascular disease ( CVD ) . Although microvascular complications can lead to significant morbidity and premature mortality , by far the greatest cause of death in people with diabetes is CVD . Results from r and omized controlled trials have demonstrated conclusively that the risk of microvascular complications can be reduced by intensive glycemic control in patients with type 1 ( 1,2 ) and type 2 diabetes ( 3–5 ) . In the Diabetes Control and Complications Trial ( DCCT ) , there was an ∼60 % reduction in development or progression of diabetic retinopathy , nephropathy , and neuropathy between the intensively treated group ( goal A1C < 6.05 % , mean achieved A1C ∼7 % ) and the st and ard group ( A1C ∼9 % ) over an average of 6.5 years . The relationship between glucose control ( as reflected by the mean on- study A1C value ) and risk of complications was log-linear and extended down to the normal A1C range ( < 6 % ) with no threshold noted . In the UK Prospect i ve Diabetes Study ( UKPDS ) , participants newly diagnosed with type 2 diabetes were followed for 10 years , and intensive control ( median A1C 7.0 % ) was found to reduce the overall microvascular complication rate by 25 % compared with conventional treatment ( median A1C 7.9 % ) . Here , too , secondary analyses showed a continuous relationship between the risk of microvascular complications and glycemia extending into the normal range of A1C , with no glycemic threshold . On the basis of these two large controlled trials , along with smaller studies and numerous epidemiologic reports , the consistent findings related to microvascular risk reduction with intensive glycemic control have led the American Diabetes Association ( ADA ) to recommend an A1C goal of < 7 % for most adults with diabetes ( 6 ) , recognizing that more or less stringent goals may be appropriate for certain patients . Whereas many epidemiologic studies and meta-analyses
Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
Objectives Poorly controlled type 2 diabetes mellitus ( T2DM ) is a major international health problem .