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Appropriate target for glycemic control debated

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The Endocrine Society 90th Annual Meeting

The ideal glycemic target for patients with diabetes was debated during a session today.

Lois Jovanovic, MD, CEO and chief scientific officer of Sansum Diabetes Research Institute in Santa Barbara, Cali, and Richard M. Bergenstal, MD, executive director of the International Diabetes Center at Park Nicollet, in Minneapolis, Minn presented their viewpoints during a session today.

Jovanovic presented findings from various studies, including ACCORD, UKPDS and the Diabetes Control and Complications Trial to demonstrate the evidence for utilizing a glycemic target ,6.5%. There is evidence that the target must be decreased to less than 6.5% for type 1 diabetes, type 2 diabetes and diabetes and pregnancy, according to Jovanovic. The lower target minimizes the risk associated with hypoglycemia and weight gain.

“Do not conclude what the New England Journal of Medicine said: That there is an unrecognized risk for intensive glucose control,” Jovanovic said during the debate. “We recognize the risks; therefore, we can do it safely.”

Bergenstal presented findings from various studies, including ACCORD, ADVANCE, the Veterans Affairs Diabetes Trial, and the Treating to Target in Type 2 Diabetes trial (4-T) to demonstrate the evidence for utilizing a glycemic target ,7.0%. Consequences of pushing for an HbA1c ,6.5% include patient difficulty with maintaining a strict diet, exercise and self-monitoring of blood glucose regimen and higher rates of weight gain and hypoglycemic events, according to Bergenstal.

“Lowering HbA1c ,7.0% will reduce microvascular complications, but will not increase cardiovascular events or mortality and will minimize potential health hazards,” he said during the debate. – by Christen Haigh

For more information:

• Jovanovic L, Bergenstal R, et al. Glycemic control: What is the target? #D3-1, D32. Presented at: The Endocrine Society’s 90^th Annual Meeting; June 15-18, 2008; San Francisco.