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Intensive Glucose-Lowering Therapy in Diabetes

Report type: Yellow
Published: 2009
Language information: Fulltext report in Swedish. Summary and conclusions in English.
Contact person SBU: Sophie Werkö  E-mail: werko@sbu.se

 

Conclusions

  • Intensive insulin therapy for type 1 diabetes is demanding for
    health services and the patient alike, but reduces the risk for
    cardiovascular disease and substantially reduces the risk for damage
    to the retina, kidneys, and nerves. The risk is increased
    for serious hypoglycemia, which places the greatest limitation
    on treatment. In many patients, successful intensive therapy
    should reduce diabetes complications in the long term. Treatment
    is cost effective.
  • In newly diagnosed type 2 diabetes, intensive glucose-lowering
    therapy helps reduce the risk of cardiovascular disease and
    serious damage to the retina of the eye. Treatment is relatively
    simple, and the risks for side effects are small. Successful intensive
    therapy of newly diagnosed type 2 diabetes should reduce
    such complications in the long term. Treatment is cost effective.
  • In patients who have had type 2 diabetes for 5 to 10 years, or
    longer, the benefits of intensive glucose-lowering therapy are
    not uniformly greater than the risks, and the cost effectiveness
    is not clear. The risk for kidney damage is somewhat reduced.
    Studies present conflicting findings regarding the risk for cardiovascular
    diseases. It is important to individualize the treatment
    goals for these patients and balance the risks of side
    effects (eg, serious hypoglycemia) against the risks of late diabetes
    complications, which increase with the rise in HbA1c.
    New studies with longer follow-up are urgently needed in this
    patient group.