Sandeep Vijan, MD, MS; Timothy P. Hofer, MD, MS; Rodney A. Hayward, MD
Vijan S., Hofer T., Hayward R.; Estimated Benefits of Glycemic Control in Microvascular Complications in Type 2 Diabetes. Ann Intern Med. 1997;127:788-795. doi: 10.7326/0003-4819-127-9-199711010-00003
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Published: Ann Intern Med. 1997;127(9):788-795.
The benefits of intensive glycemic control in patients with type 2 diabetes are not well quantified. It is therefore not clear which patients will benefit most from aggressive glycemic control.
To evaluate the efficacy of glycemic control in type 2 diabetes.
Markov decision model.
Diabetic patients at a health maintenance organization.
Risks for developing blindness and end-stage renal disease; number of patients and patient-years needed to treat to prevent complications.
For a patient in whom diabetes developed before 50 years of age, reducing hemoglobin A1c levels from 9% to 7% results in an estimated 2.3-percentage point decrease (from 2.6% to 0.3%) in lifetime risk for blindness due to retinopathy. The same change in a patient with diabetes onset at 65 years of age would be expected to decrease the risk for blindness by 0.5 percentage points (from 0.5% to <0.1%). However, the Markov model predicts substantially greater benefit when moving from poor to moderate glycemic control than when moving from moderate to almost-normal glycemic control. Targeting less than 20% of the patients at one health maintenance organization for intensified therapy may prevent more than 80% of the preventable patient-time spent blind. The risks for end-stage renal disease and the risk reduction provided by improved glycemic control are lower than those for blindness.
This probability model, based on extrapolation from the experience with type 1 diabetes, suggests that patients with early onset of type 2 diabetes will accrue substantial benefit from almost-normal glycemic control. In patients with later onset, moderate glycemic control prevents most end-stage complications caused by microvascular disease. These results have important implications for informing patients and allocating health care resources.
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Cardiology, Endocrine and Metabolism, Diabetes, Coronary Risk Factors.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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