Kumamoto and Other Studies: is there More Evidence? Vepidemiologic and Interventional Studies

Abstract

<h2>ABSTRACT</h2><h3>Purpose</h3> To review several epidemiologic and interventional studies of glycemic control and complications for data relevant to formulation of guidelines. <h3>Findings</h3> All the epidemiologic studies reviewed demonstrate that an increasing glycated hemoglobin value or a glycated hemoglobin level >7.0% is associated with increases in diabetes-related complications and all-cause mortality. The interventional studies, characterized by the Kumamoto Study, revealed results similar to those from the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study in (1) the value of intensive therapy in lowering glycated hemoglobin levels and (2) the reduction of diabetes complications associated with decreasing glycated hemoglobin levels. The Veterans Affairs Cooperative Study of diabetes mellitus, unlike other studies reviewed, enrolled subjects with long-standing type 2 diabetes. In this group, intensive therapy was associated with an increased incidence of cardiovascular events in comparison with the standard-therapy group—a finding that needs confirmation and further investigation. <h3>Conclusion</h3> Aggressive glycemic control is likely to reduce the incidence of microvascular and macrovascular complications in patients with type 2 diabetes.