In 1993, the Diabetes Control Complications Trial (DCCT) study established that chronic hyperglycemia initiates and progresses to microvascular complications such as retinopathy in type 1 diabetes mellitus (T1DM). The milestone message from DCCT has been that early near-normalization of blood glucose in recent-onset T1DM with glycated hemoglobin (HbA1C) <7.0% prevents the appearance and delays progression of microvascular complications. To achieve this, the physiological model of insulin substitution is needed with basal insulin for the fasting state and prandial insulin at each carbohydrate meal. This can be achieved with continuous subcutaneous insulin infusion (CSII), the gold-standard approach to substituting basal insulin, or multiple daily insulin injections (MDI) using long-acting insulin analogues as basal insulin (glargine or degludec once a day, detemir twice a day) with very similar results. Neutral protamine Hagedorn should be totally dismissed in the treatment of T1DM. It does not really matter whether CSII or MDI is used, as long as HbA1C is maintained <7.0% in each treatment. Unfortunately, only a minority of T1DM patients reach this target. To increase the success of intensive treatment, education of diabetologists, the diabetes team, and the diabetic subjects on how to use insulin, diet, and physical exercise are strongly needed.
Glucose Control in Diabetes: Targets and Therapy
BOLLI, Geremia Brunetto;PORCELLATI, Francesca;LUCIDI, Paola;FANELLI, Carmine Giuseppe
2015
Abstract
In 1993, the Diabetes Control Complications Trial (DCCT) study established that chronic hyperglycemia initiates and progresses to microvascular complications such as retinopathy in type 1 diabetes mellitus (T1DM). The milestone message from DCCT has been that early near-normalization of blood glucose in recent-onset T1DM with glycated hemoglobin (HbA1C) <7.0% prevents the appearance and delays progression of microvascular complications. To achieve this, the physiological model of insulin substitution is needed with basal insulin for the fasting state and prandial insulin at each carbohydrate meal. This can be achieved with continuous subcutaneous insulin infusion (CSII), the gold-standard approach to substituting basal insulin, or multiple daily insulin injections (MDI) using long-acting insulin analogues as basal insulin (glargine or degludec once a day, detemir twice a day) with very similar results. Neutral protamine Hagedorn should be totally dismissed in the treatment of T1DM. It does not really matter whether CSII or MDI is used, as long as HbA1C is maintained <7.0% in each treatment. Unfortunately, only a minority of T1DM patients reach this target. To increase the success of intensive treatment, education of diabetologists, the diabetes team, and the diabetic subjects on how to use insulin, diet, and physical exercise are strongly needed.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
