ADA/JDRF Type 1 Diabetes Sourcebook, Excerpt # Setting Treatment Targets, Part 2 of 2
The following is a list of more urgent questions. It is clear that the optimal targets for T2D cannot always be extrapolated to patients with T1D, since the pathophysiology, disease course, and management differ so markedly. In patients with T1D, it is likely that glycemic control is even more important than for T2D, although other factors such as blood pressure and lipids play a key role.
Targets should include A1C, but A1C alone has little utility for making specific adjustments in glucose-lowering therapy. Instead targets should include goals for glucose in a variety of circumstances, such as fasting, premeal and postmeal, and possibly for glycemic variability. In general, targets must be individualized to fit the specific circumstances of the patient, taking into account the risks and benefits of the intervention, particularly in the case of glucose targets.
Newer technologies may allow tighter targets over time without increasing the risk of hypoglycemia. Therefore, targets should be frequently reevaluated among individuals and among the population as a whole. Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term in insulin-dependent diabetes mellitus.
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An analysis of the diabetes control and complications trial database.
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Int J Clin Pract Suppl. Diabetes Control and Complications Trial Research Group: The relation-ship of glycemic exposure HbA1c to the risk of development and progres-sion of retinopathy in the diabetes control and complications trial.
Endocr Pract 17 Suppl. Diabetes Technol Ther —, Breton M, Clarke W, Farhy L, Kovatchev B: A model of self-treatment behavior, glucose variability, and hypoglycemia-associated autonomic failure in type 1 diabetes. J Diabetes Sci Technol —, J Clin Endocrinol Metab —, Rodbard D: Clinical interpretation of indices of quality of glycemic control and glycemic variability. Postgrad Med —, Foo JP, Mantzoros CS: The quest for the perfect biomarker of long-term gly-cemia: new studies, new trials and tribulations. Metabolism —, Diabe-tes —, Clin-ical Management Guidelines for Obstetrician-Gynecologists.
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Number 60, March Pregestational diabetes mellitus. Obstet Gynecol , International Diabetes Federation, Brussels. Accessed 20 March Diabetes Care , Kerssen A, de Valk HW, Visser GH: Increased second trimester maternal glucose levels are related to extremely large-for-gestational-age infants in women with type 1 diabetes. Diabetes Care —, Am J Obstet Gynecol —, Obstet Gynecol —, Endocrinol Metab Clin N Am —, Diabetes Care. J Clin Endocrinol Metab —38, Ann Intern Med —, N Engl J Med —, Fort A, Narsinghani U, Bowyer F: Evaluating the safety and efficacy of Glucommander, a computer-based insulin infusion method, in management of diabetic ketoacidosis in children, and comparing its clinical performance with manually titrated insulin infusion.
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J Pediatr Endocrinol Metab — , Hirsch IB: Intravenous bolus insulin delivery: implications for closed-loop control and hospital care. Diabetes Technol Ther —7, Arch Intern Med —, Diabetologia 45 : — , Zgibor JC, Orchard TJ: Has control of hyperlipidemia and hypertension in patients with type 1 diabetes improved over time? Diabetes , Diabet Med —, BMJ —, Lancet —, JAMA —68, A meta-analysis of individual patient data. BMJ , Hypertension —, Watts GF, Karpe F: Triglycerides and atherogenic dyslipidaemia: extend-ing treatment beyond statins in the high-risk cardiovascular patient.
Heart —, Kara C, Cetinkaya S, Sezgin N, Kinik ST: The effects of metabolic control on oxidized low-density lipoprotein antibodies in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes —22, Atherosclerosis —, Sign in to Purchase Instantly.
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