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Diabetes Mellitus, Type 1 > Drug Therapy Author: Maureen D. Passaro, MD; Robert E. Ratner, MD
Editorial changes - 2012-02-07
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Rationale:

  • Poorly controlled diabetes is associated with increased chronic complications.
  • The risk of tight control should not outweigh the risk of hypoglycemia.

Evidence:

  • The Diabetes Control and Complications Trial, the largest and longest prospective clinical trial, has shown that lowering the blood glucose level slows or prevents diabetic complications (25).
  • The Diabetes Control and Complications Trial showed that there is a direct relationship between HbA1c and risk reduction. For each proportionate reduction in HbA1c, there is a proportionate reduction in risk (88).
  • Intensely treated patients in the Diabetes Control and Complications Trial had a threefold increase in hypoglycemic events. The goals may need to be sacrificed in people who have frequent severe hypoglycemia that cannot be avoided by adjusting therapy (89; 90).
  • Severe hypoglycemia can cause a heart attack or stroke in older patients (91).

Comments:

  • None.
FAQs
Abd A. Tahrani, MD, MRCP, editorial consultant, received a grant from the UK Novo Nordisk Research Foundation. Maureen D. Passaro, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Robert E. Ratner, MD, is a consultant for Amylin Pharmaceuticals, AstraZeneca, GlaxoSmithKline, Lifescan, Inc., NovoNordisk, Sanofi-Aventis, Takeda, owns stocks in Merck, Johnson & Johnson, Abbott, received grants from Amylin, AstraZeneca, Bayhill Therapeutics, Boehringer Ingelheim, Conjuchem, Inc., Eil Lilly, GlaxoSmithKline, Merck, NovoNordisk, Pfizer, Sanofi-Aventis, Takeda.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.

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