Format

Send to

Choose Destination
See comment in PubMed Commons below
Ann Intern Med. 1997 Nov 1;127(9):788-95.

Estimated benefits of glycemic control in microvascular complications in type 2 diabetes.

Author information

1
Veterans Affairs Center for Practice Management and Outcomes Research, Ann Aroor, Michigan, USA.

Abstract

BACKGROUND:

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.

OBJECTIVE:

To evaluate the efficacy of glycemic control in type 2 diabetes.

DESIGN:

Markov decision model.

PATIENTS:

Diabetic patients at a health maintenance organization.

MAIN OUTCOME MEASURES:

Risks for developing blindness and end-stage renal disease; number of patients and patient-years needed to treat to prevent complications.

RESULTS:

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.

CONCLUSIONS:

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.

Comment in

PMID:
9382399
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Support Center