The Management of both type 1 diabetes (T1DM) and type 2 diabetes (T2DM) involves careful monitoring and treatment of hypertension, hyperlipidaemia and hyperglycaemia. Aggressive treatment of high blood pressure and high cholesterol has been proven effective in reducing mortality in both T1DM and T2DM. Various guidelines advocate certain values for blood pressure and for cholesterol to be aimed for. These cut-off values have been pushed downwards constantly during the last 3 decades. The lower, the better has been the mantra although some have cautioned, that a lower limit exist from where a further reduction will not be beneficial, or even harmful (the J-curve phenomenon). Recent prospective studies indicate, that this phenomenon does exist as regards antihypertensive therapy at least in certain patient groups.
The association between glycaemic control and the development of microangiopthy has been obvious for many years, and prospective studies have proven glycaemic intervention to be effective. The clinical problem here deals with the delicate balance between avoiding prolonged hyperglycaemia leading to late complications (Scylla) and hypoglycaemia threatening life and well being of the patients (Charybdis). Studies within the last 5 years have suggested the presence of the J-curve phenomenon as regard glycaemic control leading to a revision of the therapeutic targets.
30 Apr - 04 May 2011
European Society of Endocrinology