TREATMENT TARGETS FOR DIABETES
UKPDS Study 1998

* looked at patients with newly diagnosed DM assigned intensive control with METFORMIN, Sulfonylurea or insulin or conventional treatment with diet alone.
* Median HbA1C of 7.0-7.9% only achieved.
* only half achieved target 7.0% even after intensive treatment.
* better control lead to 12% reduction in all diabetes endpoints ESP. microvascular events.
* MI and all-cause mortality reduced in obese patients treated with MTF as firstline.

ACCORD STUDY 2008

* 10,000 patients, average age 62 years with longstanding disease and had established CVD or increased risk
* randomised to intensive therapy to reach HBA1C 6.0% or conventional therapy 7.0-7.9%

Trial stopped: all-cause MORTALITY INCREASED with INTENSIVE glucose lowering ( 5.0% vs 4.0%)
-->reasons for death unknown

AUSTRALIAN TREATMENT TARGETS

* general target: <7.0%
* Diabetes if short duration (10 years in younger patients/<20 years in older patients and no cardiovascular disease)
* + require lifestyle modification=<6.0%
* +require antidiabetics other than MTF and insulin=<6.5%
* requiring insulin =<7.0%
* Pregnancy or planning pregnancy=<6.0%
* Diabetes of longer duration or clinical cardiovascular disease=<7.0%
* Recurrent severe hypoglycemia or hypoglycemia unawareness <8.0%

HBA1C vs estimated average glucose (mmol/L)

* 5% = 5.4mmol/L
* 6% =7.0mmol/L
* 7%=8.6 mmol/L
* 8%=10.2 mmol/L
* 9%=11.8 mmol/L
* 10%= 13.4 mmol/L
* 11%=14.9 mmol/L
* 12%=16.5 mmol/L

DATA FROM DIABETES CARE;2008; 1473-1478.