Chapter 12. Can Intensive Glycemic Management in Type 1 Diabetes Reduce Morbidity and Mortality?

  1. R. Williams1,
  2. W. Herman2,
  3. A.-L. Kinmonth4 and
  4. N. J. Wareham3
  1. William Herman

Published Online: 9 APR 2003

DOI: 10.1002/0470846585.ch12

The Evidence Base for Diabetes Care

The Evidence Base for Diabetes Care

How to Cite

Herman, W. (2002) Can Intensive Glycemic Management in Type 1 Diabetes Reduce Morbidity and Mortality?, in The Evidence Base for Diabetes Care (eds R. Williams, W. Herman, A.-L. Kinmonth and N. J. Wareham), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/0470846585.ch12

Editor Information

  1. 1

    Nuffield Institute for Health, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK

  2. 2

    Department of Internal Medicine and Epidemiology, 1500 East Medical Center Drive, 3920 Taubman Center, Box 0345, Ann Arbor, MI 48109, USA

  3. 3

    Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

  4. 4

    General Practice and Primary Care Research Unit, Dept. of Public Health & Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

Author Information

  1. Department of Internal Medicine and Epidemiology, 1500 East Medical Center Drive, 3920 Taubman Center, Box 0345, Ann Arbor, MI 48109, USA

Publication History

  1. Published Online: 9 APR 2003
  2. Published Print: 27 AUG 2002

ISBN Information

Print ISBN: 9780471988762

Online ISBN: 9780470846582

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Keywords:

  • congenital malformation;
  • glycemic control;
  • microvascular complication;
  • neuropathic complication;
  • glycemic management;
  • hypoglycemia;
  • intensive therapy;
  • cardiovascular disease

Summary

The ‘glucose hypothesis’ attributes the complications of diabetes to chronic hyperglycemia. New technologies have enabled prospective clinical trials to be conducted to test this hypothesis. Major congenital malformations are the leading cause of morbidity and mortality in infants of mothers with established diabetes. These malformations develop by eight weeks gestation. Studies showed that improved glycemic control before conception and early in gestation reduced the rate of major malformations compared with a poorly controlled group. Ethical considerations prevent a randomized study of this. The benefits of glycemic control in preventing microvascular and neuropathic complications have been shown in many studies, the most recent being the Diabetes Control and Complications Trial. Intensive therapy may be associated with a reduction in adverse cardiovascular outcomes and cardiovascular mortality but long-term follow up studies are required. Intensive glycemic management does have some risks, particularly an increased incidence of hypoglycemia. The answer lies in balancing the risks and benefits of intensive therapy.