| The goals of treatment in diabetes are the prevention of acute and chronic complications
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| Perhaps the single most important change in the field in the last decade has been the change in therapeutic approach to diabetes from that focused exclusively on the control of glycemia to the parallel management of cardiovascular risk factors.
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| The maintenance of good glycemic control had been long-recognized as fundamental for diabetes care. Two major clinical trials, the Diabetic control and Complications trial (DCCT) in type 1 diabetes, and the UK Prospective Diabetes Study (UKPDS) in type 2 patients confirmed the long-held view that microvascular complications are associated with the level of glycemia. The results of both trials also suggest that the level of glycaemia is not a major determinant of atherosclerotic disease. On the other hand, there is an increasing evidence that it is the intervention which includes glycemic control and the management of cardiovascular risk that is most effective in the prevention of the long-term complications.
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Thus, in addition to striving to maintain the concentration of plasma glucose close to normal, the intensive management of cardiovascular risk factors such as hypertension and dyslipidemia is necessary. This is in line with the recent clinical recommendations such as the JNC 7 Report on treating blood pressure and the recommendations of the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program on treatment of dyslipidemia (both are included in the Further Reading list at the end of this chapter).
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| SEVERE HYPOGLYCEMIA IS A MEDICAL EMERGENCY |
| A 12-year-old diabetic boy was playing with his friends. He received his normal insulin injection in the morning but continued playing through the lunch time without a meal. He became confused and then lost consciousness. He was given an injection of glucagon from the emergency kit his father carried, and recovered within minutes. |
| Comment. An immediate improvement after glucagon injection confirms that this boy's symptoms were caused by hypoglycemia, caused by the exogenous insulin and insufficient food intake. Recovery from hypoglycemia was due to the action of glucagon. In the hospital, hypoglycemic patients who cannot eat or drink are treated with an intravenous infusion of glucose. An intramuscular glucagon injection is an emergency measure that can be applied at home. |
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