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[IPk] macrovascular complications

There is certainly evidence to suggest that tight blood glucose control
reduces the risk of microvascular disease, the most important trial probably
being the Diabetes control and complications trial. With macrovascular
disease, it seems that tight control may be less important than treatment of
high blood pressure. The diabetes control and complications trial
demonstrated a small decrease risk of macrovascular disease, but this was
only over 6 or 7 years and in young adults in whom events are rare anyway.
Perhaps if the trial was continued on a far more long term basis, a larger
effect would have been seen. Another trial looking at tight vs conventional
control of type 2 DM demonstated a very small decrease in risk attributable
to the tighter control. Control of hypertension was found to be more
important. But tight control of BG was associatd with less risk of
developping small vessel disease again.
In both these trials the HbA1c acheived in the intensive treatment groups
averaged about 7 %, which is still higher than that of the non diabetic
population although I dream of acheiving this result
So if more of us could sucsessfully reduce our HbA1c to well below this
further benefits may be seen. Some people manage to acheive these targets on
intensified injection or pump therapy
Loss of weight and other lifestyle measures such as regular exercise would
help to control BP and cholesterol and may also improve diabetes control, so
a general modification of lifestyle would be beneficial in reducing the risk
of large and small vessel disease
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