This Guideline addresses the topic of blood glucose control in people with type 2 diabetes and provides guidance on a number of issues relating to the assessment and management of blood glucose levels in people with type 2 diabetes.
Type 2 diabetes is associated with reduced life expectancy, significant morbidity due to the specific diabetes related microvascular complications (retinopathy, nephropathy and neuropathy), and the increased risk of macrovascular complications (ischemic heart disease, stroke and peripheral vascular disease). The development of these complications impacts on quality of life.
In Australia, type 2 diabetes results in premature death and irreversible long term complications including myocardial infarction, stroke, retinopathy and blindness, renal disease requiring dialysis or transplantation, neuropathy, foot ulcer, amputation, and erectile dysfunction.
In 2004, diabetes was among the top ten leading causes of death being the direct cause of 2.7% of deaths in Australia, and being associated with another 6% of deaths (Australian Bureau of Statistics, 2006). Cardiovascular disease is the major cause of death in people with diabetes, accounting for approximately 50% of all fatalities (International Diabetes Federation, 2006). In 2005, diabetes was associated with cause of death in nearly 11,900 Australian deaths or 9% of all deaths that year. Approximately half of these deaths involved CHD (48%), stroke (16%), and PVD in 6% of diabetes deaths (Diabetes: Australian Facts 2008).
Over 81,000 hospitalisations occurred in 2004-05 where both diabetes and CHD were present, which accounted for 15.3% of all diabetes hospitalisations. In the same years, stroke from diabetes amounted to 2.2% of all diabetes hospitalisations and peripheral vascular disease accounted for 5.9% of all diabetes hospitalisations (Diabetes Australian Facts, 2008).
Age at diagnosis has an important influence on the occurrence of outcomes. People who were older at diagnosis had more complications at baseline (1997). However, a recent study reported an increased inherent susceptibility to retinopathy with earlier onset diabetes (Wong et al., 2008). Even after adjusting for glycaemic exposure, age of diagnosis was an independent predictor of long term retinopathy. Furthermore, young adults with early-onset diabetes are at a much greater risk of CVD relative to matched controls (Hillier and Pedula, 2003). Hanefeld et al (1996) found that all-cause mortality in newly diagnosed type 2 diabetes followed for 12 years was increased 5.1-fold in males and 7-fold in women aged 36-45 and 2-fold in males and 3.5-fold in women aged 46-55 years. While there is evidence in the general population that mortality from heart disease is decreasing, the pattern in people with diabetes is different. In an 8 year observational follow-up of the NHANES cohort, there was a 36.4% decline in age-adjusted heart disease mortality in non-diabetic men and only a 13.1% decline in diabetic men. For women, the situation was even worse with a decline of 27% in non-diabetic women, but an increase of 23% in diabetic women (Gu et al., 1999).
Over the past decade intervention studies have examined the effect of lowering blood glucose levels in people with type 2 diabetes. This section examines the evidence of the relationship between blood glucose control and diabetes vascular complications and the impact on quality of life.
Contents
Glossary of Acronyms
Expert Advisory Group
Introduction
Questions for blood glucose control
Summary of recommendations and practice points
Section 1: What is the effect of improving blood glucose control on:
- a) Microvascular complications (retinopathy, neuropathy, nephropathy)?
b) Macrovascular complications (heart disease, stroke, peripheral vascular disease)?
c) Quality of life?
Background
Evidence Section
Section 2: Are there any potentially harmful effects of improving blood glucose control?
- Background
Evidence Section
Section 3: How should blood glucose control be assessed?
- Background
Evidence Section
Section 4: What are the targets for blood glucose control?
- Background
Evidence Section
Section 5: What lifestyle modification and therapeutic interventions can be used to improve blood glucose control in people with type 2 diabetes?
- Background
Evidence Section
Section 6: What are the economic consequences of and socio-economic influences on blood glucose control?
- Background
Evidence Section
References
Appendices
- Appendix 1: Guideline Search Strategy and Yield
Appendix 2: Overview of Guideline Development Process and Methods
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Evidence Based Guideline for Blood Glucose Control in Type 2 Diabetes
