Hypoglycemia: An Excuse for Poor Glycemic Control?

What is the evidence supporting the benefits of intensified glycemic control for diabetic patients? The Diabetes Control and Complications Trial (DCCT) and the Stockholm Diabetes Intervention Study (SDIS) showed that intensive therapy significantly reduced the incidence and progression of microvascular complications in patients with type 1 diabetes. In the DCCT, during a mean of 6.5 years, diabetic retinopathy developed or progressed in 14% of patients with type 1 diabetes who were treated intensively compared with 32% of patients treated conventionally. Nephropathy and neuropathy also developed or progressed at lower rates in the intensively treated group.1–3 The United Kingdom Prospective Diabetes Study (UKPDS) and the Kumamoto study determined that stricter glycemic control could be useful in delaying the onset and progression of diabetic microvascular complications in patients with type 2 diabetes.4,5 The Wisconsin Epidemiological Study of Diabetic Retinopathy showed that higher levels of glycemia are related to decreasing quality of life.6 Analyses of data from these and other studies suggest that, by whatever means, intensive therapy with the goal of achieving normoglycemia should be implemented as early as possible in patients with either type 1 or type 2 diabetes. Theoretically, this could improve patient quality of life and save medical resources (Figure 1). Thus, there is no