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Glycemic control in diabetes mellitus: have changes in therapy made a difference?
D M Nathan1, C McKitrick, M Larkin
1Department of Medicine, Massachusetts General Hospital, Boston 02114, USA.
The American Journal of Medicine
|February 1, 1996
Summary
Glycemic control improved in insulin-dependent diabetes mellitus (IDDM) patients between 1985 and 1993, linked to increased self-monitoring and insulin use. Non-insulin-dependent diabetes mellitus (NIDDM) patients also saw improved glycemic control, particularly those on insulin.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Diabetes Mellitus Research
Background:
- Advancements in diabetes mellitus management have emerged over the last decade.
- Glycemic control is crucial for preventing long-term diabetic complications.
Purpose of the Study:
- To assess changes in glycosylated hemoglobin (HbA1c) levels in outpatient insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) populations from 1985 to 1993.
- To determine if therapeutic modifications explain observed glycemic control trends.
Main Methods:
- Retrospective analysis of HbA1c measurements from IDDM and NIDDM patients at Massachusetts General Hospital in March 1985 and March 1993.
- Chart reviews collected data on self-monitoring frequency, insulin injections, office visits, and HbA1c measurement frequency.
Main Results:
- Mean HbA1c significantly decreased in the 1993 IDDM cohort compared to 1985 (8.77% vs. 9.47%, P=0.014).
- NIDDM cohorts showed a non-significant trend towards lower HbA1c in 1993 (8.35% vs. 8.75%), which became significant after adjusting for diabetes duration.
- Insulin-treated NIDDM patients experienced the most substantial HbA1c reduction (9.53% in 1985 vs. 8.54% in 1993, P=0.004).
- Increased self-monitoring and insulin injection frequency correlated with lower HbA1c in IDDM.
Conclusions:
- Glycemic control, measured by HbA1c, improved in IDDM patients between 1985 and 1993, partly due to increased monitoring and insulin use.
- NIDDM patients, especially those on insulin, also showed improved glycemic control over the study period.
- These temporal improvements in glycemic management are expected to reduce the incidence of long-term microvascular and neurological complications in diabetic patients.