Glucose control guidelines: current concepts

The Diabetes Control and Complications Trial (DCCT) ended decades of controversy regarding the necessity of tight glycemic control for type 1 diabetes by demonstrating that glucose control using intensive insulin therapy significantly reduced long-term microvascular complications. The American Diabetes Association (ADA) guidelines empirically support the same goal of attempting to obtain normoglycemia in patients with type 2 disease; however, unlike in type 1 disease, insulin is a tertiary option, following diet, exercise, and oral agents. Emerging long-term intervention data in type 2 diabetes suggest that insulin may pose increased cardiovascular risk in this already 'at-risk' population. However, many type 2 diabetics will eventually require insulin. Clearly, more studies are warranted to assess the risks, benefits, and feasibility of improved glycemic control in type 2 diabetes. Nonetheless, two principles are clear. First, promoting blood glucose levels approaching normoglycemia is an important factor in preventing longterm microvascular complications. Second, type 2 diabetes comprises numerous metabolic conditions; therefore an integrated effort by the patient and healthcare team is required to optimize blood glucose and serum lipid levels and minimize cardiovascular risk factors.