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  1. Estimated benefits of glycemic control in microvascular complications in type 2 diabetes.

    Article - En anglais

    Background 

    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.

    Objective 

    To evaluate the efficacy of glycemic control in type 2 diabetes.

    Design 

    Markov decision model.

    Patients 

    Diabetic patients at a health maintenance organization.

    Main Outcome Measures 

    Risks for developing blindness and end-stage renal disease ; number of patients and patient-years needed to treat to prevent complications.

    Results 

    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

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 97-0549153

    Code Inist : 002B21E01C. Création : 24/03/1998.