Intensive Glucose-Lowering Therapy in Diabetes

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 HbA_1c. New studies with longer follow-up are urgently needed in this patient group.