Chapter 13. Intensive Glycaemic Management in Type 1 Diabetes: A Commentary

  1. R. Williams2,
  2. W. Herman3,
  3. A.-L. Kinmonth5 and
  4. N. J. Wareham4
  1. Brian M. Frier

Published Online: 9 APR 2003

DOI: 10.1002/0470846585.ch13

The Evidence Base for Diabetes Care

The Evidence Base for Diabetes Care

How to Cite

Frier, B. M. (2002) Intensive Glycaemic Management in Type 1 Diabetes: A Commentary, 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.ch13

Editor Information

  1. 2

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

  2. 3

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

  3. 4

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

  4. 5

    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 Diabetes, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW, Scotland, UK

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:

  • type 1 diabetes;
  • glycaemic control;
  • hypoglycaemia;
  • weight;
  • cognitive function;
  • quality of life;
  • diabetic complications

Summary

The importance of strict glycaemic control in minimising diabetic complications in type 1 diabetes has been established unequivocally by studies such as the Diabetes Control and Complications Trial. Interpretation of the trial outcomes is limited by patient selection as the participants constitute an atypical group, unrepresentative of the wider diabetic population. Strict glycaemic control was associated with a higher frequency of severe hypoglycaemia and undesirable weight gain, so that longterm application of intensive management may have a significant impact on the quality of life of individual patients. While exposure to recurrent severe hypoglycaemia did not affect cognitive function adversely, the duration of the trial may have been insufficient for a cognitive deficit to emerge. The feasibility of maintaining prolonged strict glycaemic control with current therapies is dubious and is not applicable to various subgroups of patients (such as those at the extremes of age) because of the morbidity associated with severe hypoglycaemia.