This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (89)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Neurology  • Ophthalmology  • Diabetic Retinopathy  • Alert me on articles by topic

Barak Gaster, MD; Irl B. Hirsch, MD

Arch Intern Med. 1998;158:134-140.

Type 2 diabetes is 8 to 10 times more common than type 1 diabetes, but no single large trial has established that improved glycemic control can prevent complications in type 2 diabetes. We have reviewed the results of the existing epidemiologic and clinical trial studies and have arrived at the following conclusions: (1) Strong evidence exists that improved glycemic control is effective at lessening the risks of retinopathy, neuropathy, and nephropathy in type 2 diabetes. (2) The evidence about the effect on coronary heart disease is limited and equivocal. (3) The hypoglycemic risk from improved glycemic control is significantly less in type 2 diabetes than in type 1, and weight gain seems to be modest. In conclusion, although glycemic goals should be individualized based on several clinical factors, most patients with type 2 diabetes would probably benefit from glucose lowering to a hemoglobin A_1c level between 7% and 8%.

From the Divisions of General Internal Medicine (Dr Gaster) and Metabolism, Endocrinology, and Nutrition (Dr Hirsch), Department of Medicine, University of Washington, Seattle.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Association Between Parental History of Type 2 Diabetes and Glycemic Control in Urban African Americans
Gong et al.
Diabetes Care 2008;31:1773-1776.
ABSTRACT | FULL TEXT  

Systematic Review: Comparative Effectiveness and Safety of Oral Medications for Type 2 Diabetes Mellitus
Bolen et al.
ANN INTERN MED 2007;147:386-399.
ABSTRACT | FULL TEXT  

A randomized controlled trial of duloxetine in diabetic peripheral neuropathic pain
Wernicke et al.
Neurology 2006;67:1411-1420.
ABSTRACT | FULL TEXT  

Ethnic Disparities and Trends in Glycemic Control Among Adults With Type 2 Diabetes in the U.S. From 1988 to 2002
Fan et al.
Diabetes Care 2006;29:1924-1925.
FULL TEXT  

A 26-Week, Randomized, Parallel, Treat-to-Target Trial Comparing Insulin Detemir With NPH Insulin as Add-On Therapy to Oral Glucose-Lowering Drugs in Insulin-Naive People With Type 2 Diabetes.
Hermansen et al.
Diabetes Care 2006;29:1269-1274.
ABSTRACT | FULL TEXT  

Oral Contraceptives, Angiotensin-Dependent Renal Vasoconstriction, and Risk of Diabetic Nephropathy
Ahmed et al.
Diabetes Care 2005;28:1988-1994.
ABSTRACT | FULL TEXT  

Inhibition of Transglutaminase Activity Reduces Extracellular Matrix Accumulation Induced by High Glucose Levels in Proximal Tubular Epithelial Cells
Skill et al.
J. Biol. Chem. 2004;279:47754-47762.
ABSTRACT | FULL TEXT  

Meta-Analysis: Glycosylated Hemoglobin and Cardiovascular Disease in Diabetes Mellitus
Selvin et al.
ANN INTERN MED 2004;141:421-431.
ABSTRACT | FULL TEXT  

The Value of Home Monitoring Kits in Diabetes, Hypertension, Asthma, and Oral Anticoagulation Therapy
Vincze and Parthan
Journal of Pharmacy Practice 2004;17:182-196.
ABSTRACT  

The Effects of Transdermal Estradiol Alone or with Cyclical Dydrogesterone on Markers of Cardiovascular Disease Risk in Postmenopausal Women with Type 2 Diabetes: A Pilot Study
Stojanovic et al.
ANGIOLOGY 2003;54:391-399.
ABSTRACT  

Antidiabetic Effects of Panax ginseng Berry Extract and the Identification of an Effective Component
Attele et al.
Diabetes 2002;51:1851-1858.
ABSTRACT | FULL TEXT  

Improved Postprandial Glycemic Control With Biphasic Insulin Aspart Relative to Biphasic Insulin Lispro and Biphasic Human Insulin in Patients With Type 2 Diabetes
Hermansen et al.
Diabetes Care 2002;25:883-888.
ABSTRACT | FULL TEXT  

Diabetes: Relationship to ischaemic heart disease
Timmis
Br Med Bull 2001;59:159-172.
ABSTRACT | FULL TEXT  

Anaesthetic management of patients with diabetes mellitus
McAnulty et al.
Br J Anaesth 2000;85:80-90.
FULL TEXT  

Assessing the Effectiveness of a Clinical Fellowship on Diabetes in Enhancing Diabetes Care in North Carolina
Bell et al.
The Diabetes Educator 2000;26:41-57.
 

The Cost-Effectiveness of Treating All Patients with Type 2 Diabetes with Angiotensin-Converting Enzyme Inhibitors
Golan et al.
ANN INTERN MED 1999;131:660-667.
ABSTRACT | FULL TEXT  

Oral Glibenclamide Suppresses Glucagon Secretion during Insulin-Induced Hypoglycemia in Patients with Type 2 Diabetes
Landstedt-Hallin et al.
J. Clin. Endocrinol. Metab. 1999;84:3140-3145.
ABSTRACT | FULL TEXT  

Type 2 Diabetes Mellitus: Greater Cardiovascular Risks and Greater Benefits of Therapy
Fagan and Sowers
Arch Intern Med 1999;159:1033-1034.
FULL TEXT  

Type 2 Diabetes Mellitus: Update on Diagnosis, Pathophysiology, and Treatment
Mahler and Adler
J. Clin. Endocrinol. Metab. 1999;84:1165-1171.
FULL TEXT  

Screening for diabetes: what are we really doing?
Goyder and Irwig
BMJ 1998;317:1644-1646.
FULL TEXT  

Combined high blood pressure and glucose in type 2 diabetes: double jeopardy
Mogensen
BMJ 1998;317:693-694.
FULL TEXT