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428 Glycemic Control- How Tight It Should Be?

HYPERGLYCEMIA AND DIABETIC
NEUROPATHY
Diabetic neuropathy complicates both type 1 and
type 2 diabetes. Diabetic peripheral and autonomic
neuropathies are common complications of diabe-
tes with a broad spectrum of clinical manifestations
and high morbidity. Among peripheral neuropathies
in diabetes, the most studied in clinical trials is dis-
tal symmetrical sensory motor polyneuropathy (DSP),
and among autonomic neuropathies, the most stud-
ied is cardiovascular autonomic neuropathy (CAN).
The lack of standardized, validated measures for
DSP and CAN in most large trials limits the interpre-
tations of the data. DCTT/ EDIC and other smaller
trials strongly demonstrated that intensive control
designed to achieve near normoglycemia is essential
to delaying the progression of DSP and CAN in T1D.
The effect of glycemic control on DSP and CAN are
less conclusive for T2D.
CONCLUSIONS
• In spite of the advent of newer therapeutic modal-
HYPERGLYCEMIA AND DIABETIC ities for diabetes, glycemic control remains chal-
NEPHROPATHY lenging.
Diabetes mellitus is the major cause of end stage • By keeping glycemia under control, several compli-
renal disease (ESRD) throughout the world. Diabet- cations can be prevented or at the least, delayed.
ic nephropathy does not develop in all patients with • Glycemic control can be achieved not only by tak-
diabetes and it is believed to be progressive disease ing drugs, but also through proper life style man-
from microalbuminuria to macroalbuminuria and agement.
ESRD. The diagnosis of diabetic nephropathy can
be made by the persistent presence of albumin in • Tight glycemic control early on in the natural his-
the urine, or continuous rise in serum creatinine, or tory of diabetes has far-reaching benefits for the
a reduction in GFR. A target of HbA1c ≤ 7% is appro- individual over his lifespan with respect to risk of
priate for majority of patients with nephropathy. A long-term vascular complications.
lower target will increase the risk of hypoglycaemia • Glycemic targets should be individualised, with
and might increase their risk of mortality, whereas a less stringent targets advocated for elderly pa-
higher target might accelerate the rate at which renal tients, those with longer duration of diabetes and
failure and other complications develop. multiple comorbidities.

2
GFR (mL/min/ 1.73 m ) Target
Stage Description for ≥3 months HbA1c REFERENCES
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1 Normal or ↑ GFR >90 ≤7% help in the management of diabetic retinopathy? Indian J Ophthalmol
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cialities Centre, Chennai, Tamil Nadu, India Department of Diabetology,
1
3 Moderate ↓ GFR 30–59 ≤7% Dr. Mohan’s Diabetes Specialties Centre and Madras Diabetes Research
4 Severe ↓ GFR 15–29 ≤7% Foundation, Chennai, Tamil Nadu, India
5 Kidney failure <15 or dialysis >7% (?) 2. Chandalia HB, Thadani PM. Glycemic targets in diabetes. Int J Diabetes
Dev Ctries DOI 10.1007/s13410-016-0467-8
GFR - Glomerular Filtration Rate; HbA1c,
glycated hemoglobin. 3. Newman D. Tight Glycemic Control for Type 2 Diabetes Mellitus (Over
Five Years). Medicine by the Numbers- A Collaboration of TheNNT.com
and AFP
4. Marik PE. Tight glycemic control in acutely ill patients: low evidence of
benefit, high evidence of harm! Intensive Care Med 2016;42:1475-1479.

GCDC 2017