Benefits and risks for intensive glycemic control in patients with diabetes mellitus

Overweight, obesity, pre-diabetes and diabetes have become epidemic in most of Western society. An estimated 25.8 million United States adults have diabetes and some 79 million have prediabetes and are thus at high risk for future development of diabetes. Appropriate treatment of the ABCs of diabetes [A1C, blood pressure and cholesterol (dyslipidemia)] can reduce the risk for the development and progression of diabetic complications. This paper reviews some of the research studies that support treatment goals established by the American Association of Clinical Endocrinologists/American College of Endocrinology and the American Diabetes Association. Multiple studies have demonstrated that intensive glycemic control will reduce the risk for diabetes microvascular and neuropathic disease, but none showed decreased macrovascular disease events during the initial phase of the trials, although benefit was seen in long-term follow-up of the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study. The American Association of Clinical Endocrinologists/American College of Endocrinology and the American Diabetes Association goals for glycemia informed by these studies indicate the importance of individualizing targets for patients based on factors including the duration of diabetes, presence of acute and chronic complications and life expectancy. Writing groups convened by these organizations have also developed treatment algorithms to help clinicians appropriately use both lifestyle and pharmacotherapy interventions to safely achieve glycemic targets.