The benefits of intensive glycemic control in patients with type 2 diabetes are not well quantified.
It is therefore not clear which patients will benefit most from aggressive glycemic control.
To evaluate the efficacy of glycemic control in type 2 diabetes.
Markov decision model.
Diabetic patients at a health maintenance organization.
Risks for developing blindness and end-stage renal disease ; number of patients and patient-years needed to treat to prevent complications.
For a patient in whom diabetes developed before 50 years of age, reducing hemoglobin A1c levels from 9% to 7% results in an estimated 2.3-percentage point decrease (from 2.6% to 0.3%) in lifetime risk for blindness due to retinopathy.
The same change in a patient with diabetes onset at 65 years of age would be expected to decrease the risk for blindness by 0.5 percentage points (from 0.5% to<0.1%). However, the Markov model predicts substantially greater benefit when moving from poor to moderate glycemic control than when moving from moderate to almost-normal glycemic control.
Targeting less than 20% of the patients at one health maintenance organization for intensified therapy may prevent more than 80% of the preventable patient-time spent blind.
The risks for end-stage renal disease and the risk reduction provided by improved glycemic control are lower than those for blindness. (...)
Mots-clés Pascal : Diabète non insulinodépendant, Evaluation, Facteur efficacité, Glycémie, Prévention, Complication, Microcirculation, Etude sur modèle, Epidémiologie, Homme, Décision Markov, Article synthèse, Endocrinopathie, Activité biologique, Appareil circulatoire pathologie, Vaisseau sanguin pathologie
Mots-clés Pascal anglais : Non insulin dependent diabetes, Evaluation, Effectiveness factor, Glycemia, Prevention, Complication, Microcirculation, Model study, Epidemiology, Human, Markov decision, Review, Endocrinopathy, Biological activity, Cardiovascular disease, Vascular disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0549153
Code Inist : 002B21E01C. Création : 24/03/1998.