Strict control of blood glucose in diabetic in prevention of complications.

In type 2 diabetes, the onset and progression of complications is significantly delayed by improving glycaemic control.

Up to 50% fo indiciduals with type 2 diabetes have complications at diagnosis, for example, nephropathy, retinopathy being present in approximately 20% of subjects. Progression of complications can be rapid: diabeteic nephropathy is a leading cause of end stage renal disease (ESRD), and diabetic retinopathy is the leading cause od new cases of blindness among adults.

United Kingdom Prospective Diabetes Study (UKPDS) have demonstrated that 1% decrease in glycosylated haemoglobin (HbA1c) was associated with a risk reduction of 37% for microvascular disease and 14% for myocardial infarction. Loss of glycaemic control was mirrored by a progressive decline in B-cell function of the pancreas (which has already deteriorated by 50% in the majority of individuals at the time of diagnosis as stated above)

Thus, in short, the stratergies in achieving early glycamic control:

UKPDS demonstrated that over 50% of subject were inadequately controlled with one anti diabetic agent, and after 9 years, only 25% of patients on monotherapy achieved the HbA1c target of <7%.

Treatment should be started as early as possible, on top of diet control to control the blood glucose in the body. When monotherapy fails, addign another anti-diabetic should be done promptly, if not insulin.


Reference:
C.J. Bailey et al. Earlier intervention in type 2 diabetes: the case for achieving early and sustained glycaemic control. Int J Clin Pract, Nov 2005, 59, 11, 1309-1316.