Importance of glucose control

The importance of glycemic control in reducing the microvascular complications of type 1 diabetes has been clearly demonstrated. The data are not as strong with regards to type 2 diabetes. The results of several prospective and one interventional study all report benefits of improved glycemic indices on reducing microvascular complications. In addition, the available literature evaluating the relationship between glycemic control and macrovascular disease in type 1 and type 2 diabetes clearly demonstrates the importance of glucose control. The most controversial issue is the relationship between hyperinsulinemia and accelerated atherosclerosis. This association is not consistently found in many recent large prospective studies, and there has never been a direct cause and effect relationship proven. Estimates on the economic benefits of reducing long-term microvascular and macrovascular complications in populations are staggering. In the available literature, all patients with diabetes should be educated and have access to an appropriate individualized treatment regimen with the goal to normalize or nearly normalize glycemic control. This should be the standard of care until proven otherwise.