Hipoglicemia
Páginas: 2 (282 palabras)
Publicado: 4 de enero de 2012
CANADIAN
DIABETES
ASSOCIATION
/
ASSOCIATION CANADIENNE DU DIABÈTE
Canadian
D I A
VOLUME 15 No. 3
B
E
T
E
S
LE DIABÈTE AU CANADA
FALL 2002HYPOGLYCEMIA: UNDERSTANDING THE ENEMY
Ellen L. Toth MD FRCPC, Danièle Pacaud MD FRCPC
Since the publication of the EDITORIAL Diabetes Control and Complications Trial (DCCT) (1) inpatients with type 1 diabetes, and the United Kingdom Diabetes Prospective Study (UKPDS) (2) in patients with type 2 diabetes, intensive diabetes management (IDM) is considered the standardof care for patients with diabetes. The DCCT demonstrated 40 to 60% reductions of significant microvascular complications in patients on IDM compared to the control group onconventional therapy. The UKPDS also demonstrated that intensive glycemic control is beneficial, particularly in preventing microvascular complications. Thus, the Canadian Diabetes Association(CDA) recommends strict targets for glycemic control (Table 1) (3). IDM implies frequent monitoring of plasma glucose (PG) (≥4 times a day) and careful matching of food and activity toinsulin dosing. The goal is to achieve PG as near to normal as possible, as limited by safety and modulated by individual characteristics (e.g. pregnancy, or the presence or absence ofcomplications). However, the DCCT encountered a 3-fold increase in the incidence of hypoglycemia in its intensively treated group. Thus, hypoglycemia has the potential to be therate-limiting step of IDM. A metaanalysis of the occurrence of hypoglycemia in patients with type 1 diabetes by Egger and colleagues showed a combined odds ratio for severe hypoglycemia inpatients on IDM of 2.99—the risk being inversely proportional to normalization of HbA1c (4). In patients
with type 2 diabetes, insulin is often needed to achieve a target HbA1c of
DIABETES
ASSOCIATION
/
ASSOCIATION CANADIENNE DU DIABÈTE
Canadian
D I A
VOLUME 15 No. 3
B
E
T
E
S
LE DIABÈTE AU CANADA
FALL 2002HYPOGLYCEMIA: UNDERSTANDING THE ENEMY
Ellen L. Toth MD FRCPC, Danièle Pacaud MD FRCPC
Since the publication of the EDITORIAL Diabetes Control and Complications Trial (DCCT) (1) inpatients with type 1 diabetes, and the United Kingdom Diabetes Prospective Study (UKPDS) (2) in patients with type 2 diabetes, intensive diabetes management (IDM) is considered the standardof care for patients with diabetes. The DCCT demonstrated 40 to 60% reductions of significant microvascular complications in patients on IDM compared to the control group onconventional therapy. The UKPDS also demonstrated that intensive glycemic control is beneficial, particularly in preventing microvascular complications. Thus, the Canadian Diabetes Association(CDA) recommends strict targets for glycemic control (Table 1) (3). IDM implies frequent monitoring of plasma glucose (PG) (≥4 times a day) and careful matching of food and activity toinsulin dosing. The goal is to achieve PG as near to normal as possible, as limited by safety and modulated by individual characteristics (e.g. pregnancy, or the presence or absence ofcomplications). However, the DCCT encountered a 3-fold increase in the incidence of hypoglycemia in its intensively treated group. Thus, hypoglycemia has the potential to be therate-limiting step of IDM. A metaanalysis of the occurrence of hypoglycemia in patients with type 1 diabetes by Egger and colleagues showed a combined odds ratio for severe hypoglycemia inpatients on IDM of 2.99—the risk being inversely proportional to normalization of HbA1c (4). In patients
with type 2 diabetes, insulin is often needed to achieve a target HbA1c of
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