Glycaemic control: evaluation of HbA1c as a risk factor and the effect of modern insulins in clinical practice

摘要: One of the ultimate goals diabetes care is to minimise diabetic complications. When evaluating insulins it important understand what extent improvements in glycaemic control clinically relevant preventing We have thus both studied effects on most commonly used and relations between In analyses electronical tracking patient record systems data from landmark study Diabetes Control Complications Trial (DCCT) were used. Research statistical models developed estimate time-dependent HbA1c Patients receiving insulin glargine clinical practice decreased average 0.18 percentage units compared patients continuing with NPH insulin. Lean men had greatest reductions HbA1c. corresponding lispro by 0.19 achieved regular high experienced relating complications we introduced term HbA1c-variable describing different weightings combinations values. a systematic review found that baseline value was common use studies complications, but mean many values greater predictive ability. By simulations showed HbA1c-variables comprising could 100% power than value. DCCT confirm these results describe temporal relationship retinopathy. Over 6 years an HbA1c-level 8% instead 7% predicted 92% risk retinopathy when considered 50% 2.4 ago largest deleterious current historical up 5 more harmful present The salutary effect constant lower level increased steadily time since previous reduce lowering 9% 274 be treated during first 3 after diagnosis, only 2 period 9-12 prevent With also relatively small changes 0.3% low NNTof 13. conclusion, good glycemic earlier recognised Insulin improve