Impact of Controlling the ABCs of Diabetes

Impact of glycemic control

Table 1 summarizes some of the major studies that have demonstrated the impact of glycemic control on complications prevention. The Diabetes Control and Complications Trial (DCCT) showed that tight glycemic control reduced risk of microvascular disease in persons with type 1 diabetes (76% reduction in eye disease overall with 63% reduction in retinopathy, 54% reduction in nephropathy, 60% reduction in neuropathy) (9, 10). The United Kingdom Prospective Diabetes Study (UKPDS) showed that among people with type 2 diabetes, improved glycemic control (average A1c = 7% vs. average A1c = 7.9% in the conventionally treated group) led to a reduction in risk of 25% for microvascular disease overall, 17%–21% for retinopathy, and 24%–33% for albuminuria. Lower A1c values also reduced the incidence of macrovascular disease with a 16% reduction in myocardial infarction, and contributed to a 24% decrease in cataract extraction (12).

Table 1. Impact of Glycemic Control (9–11, 26)

* Not statistically significant

Impact of Blood Pressure Control

The United Kingdom Prospective Diabetes Study (UKPDS) found that improved glycemic control not only reduced diabetes complications, but also demonstrated the impact of improved blood pressure control. UKPDS participants in the “tight” control blood pressure group maintained on average for the duration of the study 10 mm Hg lower systolic and 5 mm Hg lower diastolic pressures than controls. Table 2 summarizes the impact of that reduction. Improved blood pressure control (average of 144/82 mm Hg vs. 154/87 mm Hg control) during the 8 years led to a reduction in risk of 34% for retinopathy, 47% for vision loss, 37% overall for microvascular disease, 56% for heart failure, and 44% for stroke incidence (12).

Table 2. UKPDS: Impact of Blood Pressure Control in Diabetes (12)

UK Prospective Diabetes Study Group (UKPDS) 33: Lancet. 1998; 352: 837-853.

Furthermore, clinical trials, such as ABCD (Appropriate Blood Pressure Control in Diabetes Trial) and HOPE (Heart Outcomes Prevention Evaluation Study), also show that use of an ACE inhibitor reduces the risk of heart attack, stroke, or cardiovascular death by 25%–30% in patients with type 2 diabetes, and slows the progression of the kidney damage of diabetes (14).

Impact of Cholesterol and Other Lipid Control

Among people with diabetes, 67% have one or more lipid abnormalities. Multiple studies, including CARE (Cholesterol and Recurrent Events Trial) and 4S (Scandinavian Simvastatin Survival Study), have shown that lipid therapy can reduce the risk of coronary events such as nonfatal heart attacks and CVD-related deaths, as summarized in Table 3 (13, 19).

Table 3. CARE and 4S: Impact of Cholesterol Control in Diabetes

Preventing Complications

Comprehensive diabetes care is a team effort involving self-management behaviors (see “Self-Management Support” at the end of this section) by the patient and preventive care services by health care providers. At routine visits, providers of foot, dental, and eye care and drug therapy management can monitor, prevent, and treat complications, not only for conditions specific to their professional discipline, but for the patient’s overall health. Cardiovascular disease (CVD), including heart disease and stroke, is the number one cause of death for people with diabetes. All health care providers can contribute to the reduction of risk factors for CVD, and potentially reduce other complications as well, by reinforcing control of the ABCs of diabetes:

A is for A1C, previously known as hemoglobin A1C—a test that reflects average blood glucose over the last 3 months. The goal for most people with diabetes is <7. An A1C of 7 corresponds to an average blood glucose level of 150 mg/dL.

B is for blood pressure. The goal for most people with diabetes is <130/80 mm Hg.

C is for cholesterol. The goal for people with diabetes is an LDL level of <100 mg/dL, an HDL level of >40 mg/dl in men and >50 in women, and triglycerides level of <150

Source: American Diabetes Association Standards of Medical Care, Diabetes Care 29 (Suppl.1): S4-S42, 2006 (27).

May 2007

National Diabetes Education Program (NDEP)    http://ndep.nih.gov
NIDDK, National Institutes of Health, Bethesda, MD

A Joint Initiative of the National Institutes of Health and the
Centers for Disease Control and Prevention