Background.Hyperglycemia is leading to serious chronic and acute complicationsin diabetes mellitus which are shortening and altering the patient’s life. Objective.The main purpose of the study is to investigate the correlation between HbA1c valuesand diabetic complications. Material and methods.The study enrolled 2120 diabeticpatients, 1174 women (55.4%) and 946 men (44.6%), mean age 58.3 ± 12.3 years,living in Timisoara. Results.We observed the lowest incidence of chroniccomplications of diabetes mellitus for the group having HbA1c values lower than6%. Chronic complications are increasing with the HbA1c value, with a significantthreshold at 7 % (p<0.0001). Conclusions.Optimizing glycemic control is the key toprevent or delay the occurrence of severe chronic complications of diabetes mellitus,complications which can be significantly reduced by achieving the ADArecommended HbA1c target (<7%).
1. Gerstein HC, Miller ME, Byington RP, Goff DC, Jr, et al. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358(24): 2545-2559, 2008.
2. Zhang X, Patel A, Horibe H, Wu Z, Barzi F, et al. Cholesterol, coronary heart disease, and stroke in the Asia Pacific region. Int J Epidemiol 32(4): 563-572, 2003.
3. American Diabetes Association. Standards of medical care in diabetes - 2009. Diabetes Care 32 (Suppl.1): S13-61, 2009.
4. DCCT Study Group. The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial. Diabetes 44(8): 968-983, 1995.
5. Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ et al. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 353(25): 2643-2653, 2005.
6. Stratton IM, Adler AI, Neil HA et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 321(7258): 405-412, 2000.
7. Cohen RA, Hennekens CH, Christen WG et al. Determinants of retinopathy progression in type 1 diabetes. Am J Med 107(1): 45-51, 1999.
8. Kilpatrick ES, Rigby AS, Atkin SL. The effect of glucose variability on the risk of microvascular complications in type 1 diabetes. Diabetes Care 29(7): 1486-1490, 2006.
9. Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA 290(16): 2159-2167, 2003.
10. Ray KK, Seshasai SR, Wijesuriya S et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomized controlled trials. Lancet 373: 1765-1772, 2009.
11. Patel A, MacMahon S, Chalmers J et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358: 2560-2572, 2008.
12. Ceriello A, Kilpatrick E, Akalin S et al. Intensive glucose therapy and clinical implications of recent data: a consensus statement from the Global Task Force on glycaemic control. Int J Clin Pract 63: 1421-1425, 2009.
13. Hoelzel W, Weykamp C, Jeppsson JO et al. IFCC reference system for measurement of hemoglobin A1c in human blood and the national standardization schemes in the United States, Japan, and Sweden: a method-comparison study. Clin Chem 50: 166-174, 2004.
14. Jeffcoate SL. Diabetes control and complications: the role of glycated haemoglobin, 25 years on. Diabet Med Jul 21(7): 657-66, 2004.
15. Kovatchev BP, Otto E, Cox D, Gonder-Frederick L, Clarke W. Evaluation of a new measure of blood glucose variability in diabetes. Diabetes Care 29(11): 2433-2438, 2006.
16. Lind M, Odén A, Fahlén M, Eliasson B. A Systematic Review of HbA1c Variables Used in the Study of Diabetic Complications, Diabetes & Metabolic Syndrome: Clinical Research & Reviews 282-293, 2008.
17. Brownlee M, Hirsch IB. Glycemic variability: a hemoglobin A1c-independent risk factor for diabetic complications. JAMA 295 (14):1707-1708, 2006.
18. Österbrand M, Fahlén M, Odén A, Eliasson B. A method to predict the metabolic effects of changes in insulin treatment in subgroups of a large population based patient cohort. European Journal of Epidemiology 22: 151-157, 2007.
19. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus. N Engl J Med 329 (14): 977-986, 1993.
20. Lachin JM, Genuth S, Nathan DM, Zinman B, Rutledge BN, DCCT/EDIC Research Group. Effect of glycemic exposure on the risk of microvascular complications in the Diabetes Control and Complications Trial-revisIted. Diabetes 57(4): 995-1001, 2008.
21. Mazzone T. Hyperglycaemia and coronary heart disease: the meta picture. Lancet 373: 1737-1738, 2009.
22. Calles J, Banerji M, Bonds D et al. Baseline characteristics and mortality in ACCORD. Abstract No: 88-OR. American Diabetes Association, 69th Scientific Sessions, New Orleans, June 5-9, 2009.
23. Holman RR, Paul SK, Bethel MA et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359(15): 1577-1589, 2008.
24. Stevens R, Kothari V, Adler A, Stratton I, Holman R. The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56). Clinical Science 101: 671-679, 2001.
25. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352 (9131): 837-853, 1998.
26. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352 (9131): 837-853, 1998.
27. Tamborlane WV, Beck RW, Bode BW et al. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med 359 (14): 1464-1476, 2008.