oa South African Family Practice - Glycaemic control : do no harm : forum

Volume 54, Issue 1
  • ISSN : 2078-6190
  • E-ISSN: 2078-6204



Tight glycaemic control for type 2 diabetes (T2DM) has always been a tough sell. It is rarely achieved safely, owing to noncompliance and hypoglycaemic episodes, and there has been little evidence to support it. New studies now speak of its potential harm.

The initial United Kingdom Prospective Diabetes Study (UKPDS) in 1998 was widely interpreted as evidence for tight glycaemic control, then defined as a haemoglobin A1c value of 7.0%. In fact, in this trial no reduction was demonstrated in serious clinical episodes, i.e. macrovascular events (stroke or myocardial infarction). The often quoted 22% relative risk reduction in microvascular events (renal, ophthalmic, foot) actually referred primarily to a decreased need for retinal photocoagulation. However, there was no effect on visual acuity or renal failure.

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