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Strict Control of Hyperglycaemia Early in Diabetes Helps Maintain Long-Term Glycaemic Control: Presented at IDF By Brian Hoyle MONTREAL -- October 22, 2009 -- As the time with diabetes increases, the ability to control the level of blood glucose and maintain blood glucose levels in a normal range deteriorates, making strict control of hyperglycaemia very important for maintaining long-term glycaemic control. This was the conclusion of an 8-year longitudinal study carried out by researchers from the Kawasaki Medical School, Kurashiki, Japan, that was presented here October 21 at the 20th World Diabetes Congress of the International Diabetes Federation (IDF). In type 2 diabetes, the insulin-producing pancreatic beta cells become progressively dysfunctional. Yet, how and when to enact control strategies aimed at maintaining long-term glycaemic control is unclear. As an approach to this issue, the study presented by Hidenori Hirukawa, MD, Department of Internal Medicine, Kawasaki Medical School, and colleagues analysed data gathered from 637 patients with type 2 diabetes treated at the Kawasaki Medical School hospital. The completion rate for the study was 100%. Patients were observed for an average of 7.5 +- 0.5 years. At baseline, patients’ mean age was 61.3 +- 10.0 years, had been diagnosed with diabetes for an average of 11.2 +- 8.5 years, had an average body mass index (BMI) of 23.8 +- 3.6 kg/m2, and had an average glycosylated haemoglobin (Hb A1C) level of 6.7% +- 1.1%. While the BMI of patients did not change appreciably through the observation period, the annual change of Hb A1C was 0.03% annually, producing a final average of 6.9% +- 1.1%, a significant elevation from baseline (P = .0002). The change in Hb A1C progressively increased with time; 6.3% +- 1.0% to 6.7% +- 1.3% in 0 to 5 years (n = 164; P < .0001); 6.8% +- 1.2% to 6.8% +- 1.0% in 5 to 10 years (n = 136; not significant); 7.0% +- 1.1% to 7.1% +- 1.0% in 10 to 20 years (n = 183; not significant); and 7.0% +- 1.0% to 7.1% +- 1.1% in >20 years (n = 95; not significant). Patients receiving nutrition therapy decreased from 192 (30.1% of total) at baseline to 70 (11.0%), while the number of patients receiving oral antidiabetic drug (OAD) therapy increased from 301 (48.7% of total) to 465 (73.5%). At baseline, sulphonylurea (SU) insulin secretion stimulants were used by 56.5% of the patients. By the end of the observation period, OAD use consisted of SUs in 40.2% of patients, glinides in 22.4%, metformin in 47.7%, pioglitazone in 59.6%, and alpha-glucosidase inhibitors in 35.2%. The use of only 1 OAD declined significantly with time from 49.5% to 18.3% of patients. Correspondingly, the number of patients who needed insulin therapy increased from 186 (29.7% of total) to 236 (37.0%). “Our results demonstrate that glycaemic control deteriorates in accordance with diabetes deterioration, and strongly suggest that a strict control of hyperglycaemia in the early stage is required to maintain the long-term glycaemic control,” concluded Dr. Hirukawa. Funding for this study was provided by Kawasaki Medical School. [Presentation title: The Strict Control of Hyperglycaemia in the Early Stage of Diabetes Is Important in Maintaining Long-Term Glycaemic Control - From a Longitudinal Analysis for 8 Years. Abstract O-359] E-mail this page to a friend or colleague! To print, use this version