PHRM 211 Lecture Notes - Lecture 13: Blood Sugar, 18 Months, Blood Glucose Monitoring
Document Summary
First trial to tell us what a good a1c was. Did not reduce macrovascular complications (heart attack, stroke) As soon as you hit 7% , the complication of retinopathy increases significantly. Newly diagnosed, type 2, 54 years old (10 year study) Intensive blood glucose control using sulfonylureas or insulin compared to diet. A1c (intensive vs control group): 7% vs. 7. 9% Intensive vs standard a1c target (<6% vs. 7-7. 9%) Stopped 18 months early increased risk of death. A target a1c of 6. 5% reduced nephropathy but not macrovascular complications. Ultimate decision will depend on what is important to the patient. Extension of ukpds 33 study (10 + 10 years) Not everyone agrees with canadian guidelines (va/dod guidelines 7-8-9 approach ). A frail elderly woman aged 79 years for whom, all other things being equal, an a1c target range of 8-9% would be appropriate has symptomatic hyperglycemia with polydipsia and polyuria at an a1c of 8. 8%.
