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Órgano oficial de difusión de la Federación Mexicana de Patología Clínica, AC y de la Asociación Latinoamericana de Patología Clínica/Medicina de Laboratorio

2006, Number 2

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Rev Mex Patol Clin Med Lab 2006; 53 (2)

Evaluation of three multicentric and prospectives international studies in the study and management of diabetes mellitus

Terrés-Speziale AM

Language: Spanish
References: 83
Page: 104-113
PDF size: 115.62 Kb.


ABSTRACT

Background: For many years, a close relation had been considered between chronic hyperglycemia and vascular complications of diabetes mellitus. In order to establish the possibility of preventing complications through diabetes control, during the last twenty years several studies were developed in the United Kingdom, Japan and the United States of America. These three important, transcendent, prospective, longitudinal, multicentric, randomized and well controlled protocols have confirmed the benefits of strict control of glycemia on patients with type 1 and type 2 diabetes mellitus. Purpose: This is a revision of the corresponding publications of the three protocols in order to evaluate their design and discuss outcome in order to analyze the implications on the corresponding Mexican Standard for Diabetes. NOM-015-SSA. Material and methodology: Original publications generated by UKPDS from United Kingdom, DCCT from USA and Canada and Kumamoto from Japan were reviewed and main data was organized in order to allow a meta-analysis designed to visualize similarities, differences and to establish general conclusions. Outcome: The English study is the largest and longest protocol ever perfomed on diabetes mellitus type 2 (n › 5,000). The american protocol was the only one specifically designed for diabetes mellitus type 1. All three studies included two subgroups including intensive versus conventional management. Intensive care included glucose self-monitoring (› 1 / day), with analytical goals as follows: Fasting glucose ‹ 120 mg/dL and postprandial glucose ‹ 180 mg/dL, HbA1c every three months (‹ 7.0%), insuline therapy › 3/day. Conclusions: Each and every study demonstrated a reduction on morbimortality with intensive care, including type 1 and type 2 diabetes mellitus. Glucose self-monitoring on several hours per day was demonstrated to be absolutely essential, quarterly determination of HbA1c is the best indicator of therapeutical benefit considering that for every 1% reduction on HbA1c, mortality decreases on 35% and morbidity on 25%, including a lower frequency of retinopathy 70%, with better control of nephropaty measured as lower frequency of macroalbuminuria (100-50%) and microalbuminuria (62-35%)


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