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Estimated Benefits of Glycemic Control in Microvascular Complications in Type 2 Diabetes
Abstract
BACKGROUND: The benefits of intensive glycemic control in patients with type 2 diabetes are not well quantified. It is therefore not clear which patients will benefit most from aggressive glycemic control. OBJECTIVE: To evaluate the efficacy of glycemic control in type 2 diabetes. DESIGN: Markov decision model. PATIENTS: Diabetic patients at a health maintenance organization. MAIN OUTCOME MEASURES: Risks for developing blindness and end-stage renal disease; number of patients and patient-years needed to treat to prevent complications. RESULTS: For a patient in whom diabetes developed before 50 years of age, reducing hemoglobin A1c levels from 9% to 7% results in an estimated 2.3-percentage point decrease (from 2.6% to 0.3%) in lifetime risk for blindness due to retinopathy. The same change in a patient with diabetes onset at 65 years of age would be expected to decrease the risk for blindness by 0.5 percentage points (from 0.5% to < 0.1%). However, the Markov model predicts substantially greater benefit when moving from poor to moderate glycemic control than when moving from moderate to almost-normal glycemic control. Targeting less than 20% of the patients at one health maintenance organization for intensified therapy may prevent more than 80% of the preventable patient-time spent blind. The risks for end-stage renal disease and the risk reduction provided by improved glycemic control are lower than those for blindness. CONCLUSIONS: This probability model, based on extrapolation from the experience with type 1 diabetes, suggests that patients with early onset of type 2 diabetes will accrue substantial benefit from almost-normal glycemic control. In patients with later onset, moderate glycemic control prevents most end-stage complications caused by microvascular disease. These results have important implications for informing patients and allocating health care resources.
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“The reason for the lack of reliable data on diabetic complications T2DM in our review might be explained by the low rate of these complications in the people with the largest intervention effect and the time it takes to develop these complications (Vijan 1997).”
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The Role of Models Within Economic Analysis
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“IMIB[28,29] Global diabetes[27] Eastman[25,26] Vijan[30] DCCT[31]”
BackgroundCommunication during patient-provider encounters regarding diabetes self-management.
Kruse, R. L., Olsberg, J. E., Shigaki, C. L., Oliver, D. R. P., Vetter-Smith, M. J., Day, T. M., & LeMaster, J. W. (2013) · PubMed · Cited by 28
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“A growing body of literature demonstrates that patients who maintain glycemic control reduce their risk of complications (Vijan, Hofer, and Hayward 1997; Turner et al. 1999; Stratton et al. 2000) and have lower rates of health care utilization (Menzin et al. 2001; Wagner et al. 2001) and overall…”
BackgroundCamacho, G. B., & Rosero‐Bixby, L. (2008) · BMC International Health and Human Rights · doi:10.1186/1472-698x-8-5 · Cited by 27
Huang, S. J., Galárraga, O., Smith, K. A., Fuimaono, S. D., & McGarvey, S. T. (2019) · Human Resources for Health · doi:10.1186/s12960-019-0356-6 · Cited by 31
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“018 blindness, renal failure, and amputations [10–16].”
Appropriate Application of Evidence to the Care of Elderly Patients with Diabetes
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“From disease simulation studies, we know that the benefits of intensive glucose control steadily decline as the age of onset increases because of changing background mortality [14,15].”
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Metadata
- Authors
- Vijan, S., Hofer, T. P., & Hayward, R. A.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Vijan, Sandeep
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1997-11-01
- Volume
- 127
- Issue
- 9
- Pages
- 788-795
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2075434285
- Cited by
- 228
- References
- 0
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 7 · 2020: 1 · 2019: 4 · 2018: 6 · 2017: 7 · 2016: 12 · 2015: 6 · 2014: 6 · 2013: 11 · 2012: 5
- FWCI
- 8.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (HSO 666501)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, glycemic control, tight glycemic control, microvascular complications, diabetic retinopathy, blindness, end-stage renal disease, HbA1c, Markov decision process, age at onset of diabetes, healthcare resource allocation
- MeSH terms
- Adult, Blindness, Blood Glucose, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Diabetic Retinopathy, Glycated Hemoglobin, Humans, Kidney Failure, Chronic, Markov Chains, Middle Aged, Risk Factors, Sensitivity and Specificity
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