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Care of patients with diabetes mellitus is kept to a minimum the risk of microvascular and macrovascular complications, maintaining normal blood pressure, lipid profile and
blood glucose.
Glycemic control is to maintain glycosylated hemoglobin (HbA1c) between normal limitted, because we know that good glycemic control reduces the long-term risk of microvascular complications in both types of diabetes, 1 and 2. Researchers at ADVANCE and ACCORD studies examined the effect of glycemic control on the evolution of patients with type 2 diabetes and macrovascular and microvascular disease. Both studies failed to demonstrate that good glycemic control is associated with reduced cardiovascular risk.
Reports of a potential increase in mortality rates associated with intensive glycemic control resulted in a debate on the recommendations for the treatment of type 2 diabetes, specifically aiming to establish an optimal HbA1c. Researchers have suggested that in diabetics, hypoglycemia is a possible increased risk of mortality. Because intensive glycemic control increases the risk of hypoglycemia, with some drugs than with others, it is important to assess the risks associated with the various schemes to lower blood sugar. In two meta-analysis, researchers pooled data from several major works and concluded that intensive glycemic control has a positive effect on cardiovascular outcomes. However, these meta-analysis were limited by the limitations of clinical trials analyzed.
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