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Update in Endocrinology
2001–2002 Series: Update Sessions from ACP–ASIM's 2001 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
In this update, I critically examined articles selected from more than 25 peer-reviewed journals in the endocrinology and general medicine literature. Criteria for selection included the importance of the observations and their applicability to clinical practice. The articles are broadly grouped into various areas of endocrinology.
Diabetes Mellitus and Lipids
Improvement in Glycemic Control Reduces Risk for Complications
The Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study (UKPDS), published in 1996 and 1998, respectively, showed that close control of type 2 diabetes reduced microvascular complications. The UKPDS indicated only a marginal beneficial effect on reducing risk for myocardial infarction. Stratton and colleagues report on a prospective observational analysis of 4585 patients from 23 hospital clinics throughout the United Kingdom, of whom 3642 were analyzed for relative risk for clinical complications. The goal of conventional therapy was to reduce plasma glucose levels to less than 15 mmol/L (270 mg/dL), whereas the goal of intensive therapy was to reduce glucose levels to less than 6 mmol/L (108 mg/dL).
Each 1% reduction in mean hemoglobin A1c level was associated with a 21% reduction in risk for death due to diabetes, a 14% reduction in risk for myocardial infarction, and a 37% reduction in risk for microvascular complications (for example, retinopathy). The data indicate that patients with the highest blood glucose levels would be the most likely to benefit from improved control, but no threshold of hyperglycemia for a substantive change in risk for any outcome indicated that any improvement in glycemic control will reduce risk for complications.
Monitoring Blood Pressure Is Essential to Optimal Management of Diabetes
Diabetic patients with hypertension have a greater likelihood of developing complications and a greater risk for cardiovascular events and nephropathy than nondiabetic patients with hypertension. This analysis of the same …
