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Cited by 228Diabetes Treatment and ManagementDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

The DOI matches its Crossref record.

Estimated Benefits of Glycemic Control in Microvascular Complications in Type 2 Diabetes

Vijan, Sandeep, Hofer, Timothy P., Hayward, Rodney A.·1997·Annals of Internal Medicine
DOI 10.7326/0003-4819-127-9-199711010-00003
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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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Metadata

Authors
Vijan, S., Hofer, T. P., & Hayward, R. A.
Affiliations
University of Michigan (US)
Corresponding author
Vijan, Sandeep
ORCID
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
DOI
10.7326/0003-4819-127-9-199711010-00003
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
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
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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