Slow response to loss of glycemic control in type 2 diabetes mellitus.

摘要: Background To achieve glycemic control in type 2 diabetes mellitus, the American Diabetes Association (ADA) recommends intensification of glucose-lowering therapy when glycosylated hemoglobin (HbA1c) level exceeds 8.0%. Objective study before and after initiation secondary antihyperglycemic to better understand pace patterns therapeutic failure clinical responses failure. Study design A retrospective, population-based observational study. Patients methods From a 12-year-old registry members Kaiser Permanente Northwest, large group-model HMO, we tracked histories all 570 registrants who, 1998, added metformin sulphonylurea monotherapy. Results The last HbA1c use averaged 9.4%. Metabolic decompensation accelerated over time. typically spent numerous months at had several measurements >8.0% final spike >9.0%. Persons experiencing more gradual accumulated greater burdens changing therapy. Conclusions that seemed trigger action was 9.0% or higher, not 8.0% as recommended by ADA. substantial hyperglycemic peak preceded change even this relatively tightly controlled population with mellitus. Earlier changes, but frequent testing, would prevent excursions observed. Low mean levels populations do necessarily indicate loss is being rapidly addressed for most patients. More research needed estimate impact these peaks on current well-being future complications.