THE CRITICAL ROLE OF EARLY GLYCEMIC CONTROL IN PREVENTING LONG-TERM MICROVASCULAR AND MACROVASCULAR COMPLICATIONS IN DIABETES
Main Article Content
Keywords
Diabetes mellitus, glycemic control, microvascular complications, macrovascular complications, intensive glucose management, cardiovascular risk, DCCT, UKPDS, ACCORD, ADVANCE, VADT.
Abstract
Background: Diabetes mellitus causes failure of metabolic system in microscopic and arterial vessels of the human body. Therefore research suggest that lowering the glycemic counts reduces the impacts of diabetes which affects multiple organs: eyes, kidneys and hearts. as been built through several key trials including DCCT, UKPDS, ACCORD and ADVANCE. Research continues to explore both the most suitable period for management and the best level of glucose control in medical settings.
Objectives: The review examines the prevention of diabetes through proper glycemic control to prevent microvascular and macrovascular complication. The study performs a number of clinical tests by monitoring the cardiovascular episodes and death rates by measuring glycemic control.
Methodology: The research utilized peer-reviewed journal studies which contained reported results from randomized controlled trials (RCTs) and cohort studies and meta-analyses. Five key evidence sources used for this review consist of the Diabetes Control and Complications Trial (DCCT), United Kingdom Prospective Diabetes Study (UKPDS), Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT). Authors reviewed research articles that provided information about glycemic control together with its vascular complications effects.
Results: The evidence indicated that the complications like: diabetic retinopathy, nephropathy and neuropathy can be reduced by controlled blood sugar levels. Early intensive glycemic management benefits patients both short-term and long-term according to the DCCT and UKPDS. Data from the ACCORD trial demonstrates that intense blood sugar management can increase the death rates in chronic cases therefore healthcare professionalsneed to customize their treatment approaches. The combination of ADVANCE and VADT trial results demonstrates how average blood sugar control helps lower complications while preventing dangerous drops in blood sugar.
Conclusion: Diabetes patients need immediate and extended control over their blood sugar levels to stop long-lasting complications from developing. Macrovascular benefits from intensive therapy can only be achieved through combined management of blood pressure and lipids together with the therapy. Effective patient care depends on personalized therapy that includes patients multiple health problems and individual potential risks. Extra research must be undertaken to perfect glycemic targets together with treatment methods that help individuals receive maximum benefits with minimal adverse effects.
Objectives: The review examines the prevention of diabetes through proper glycemic control to prevent microvascular and macrovascular complication. The study performs a number of clinical tests by monitoring the cardiovascular episodes and death rates by measuring glycemic control.
Methodology: The research utilized peer-reviewed journal studies which contained reported results from randomized controlled trials (RCTs) and cohort studies and meta-analyses. Five key evidence sources used for this review consist of the Diabetes Control and Complications Trial (DCCT), United Kingdom Prospective Diabetes Study (UKPDS), Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT). Authors reviewed research articles that provided information about glycemic control together with its vascular complications effects.
Results: The evidence indicated that the complications like: diabetic retinopathy, nephropathy and neuropathy can be reduced by controlled blood sugar levels. Early intensive glycemic management benefits patients both short-term and long-term according to the DCCT and UKPDS. Data from the ACCORD trial demonstrates that intense blood sugar management can increase the death rates in chronic cases therefore healthcare professionalsneed to customize their treatment approaches. The combination of ADVANCE and VADT trial results demonstrates how average blood sugar control helps lower complications while preventing dangerous drops in blood sugar.
Conclusion: Diabetes patients need immediate and extended control over their blood sugar levels to stop long-lasting complications from developing. Macrovascular benefits from intensive therapy can only be achieved through combined management of blood pressure and lipids together with the therapy. Effective patient care depends on personalized therapy that includes patients multiple health problems and individual potential risks. Extra research must be undertaken to perfect glycemic targets together with treatment methods that help individuals receive maximum benefits with minimal adverse effects.
References
1. ACCORD Study Group. (2008). Effects of intensive glucose lowering in type 2 diabetes. New England Journal of Medicine, 358(24), 2545-2559. https://doi.org/10.1056/NEJMoa0802743
2. ADVANCE Collaborative Group. (2008). Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. New England Journal of Medicine, 358(24), 2560-2572. https://doi.org/10.1056/NEJMoa0802987
3. American Diabetes Association. (2022). Glycemic targets: Standards of medical care in diabetes—2022. Diabetes Care, 45(Suppl. 1), S83-S96. https://doi.org/10.2337/dc22-S006
4. Brown, J. B., Nichols, G. A., & Perry, A. (2004). The burden of treatment failure in type 2 diabetes. Diabetes Care, 27(7), 1535-1540. https://doi.org/10.2337/diacare.27.7.1535
5. Chalmers, J., & Cooper, M. E. (2008). UKPDS and the legacy effect. New England Journal of Medicine, 359(15), 1618-1620. https://doi.org/10.1056/NEJMe0807265
6. Diabetes Control and Complications Trial (DCCT) Research Group. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine, 329(14), 977-986. https://doi.org/10.1056/NEJM199309303291401
7. Duckworth, W., Abraira, C., Moritz, T., Reda, D., Emanuele, N., Reaven, P., ... & Huang, G. D. (2009). Glucose control and vascular complications in veterans with type 2 diabetes. New England Journal of Medicine, 360(2), 129-139. https://doi.org/10.1056/NEJMoa0808431
8. Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group. (2003). Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy. JAMA, 290(16), 2159-2167. https://doi.org/10.1001/jama.290.16.2159
9. Gaede, P., Vedel, P., Larsen, N., Jensen, G. V., Parving, H. H., & Pedersen, O. (2003). Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. New England Journal of Medicine, 348(5), 383-393. https://doi.org/10.1056/NEJMoa021778
10. Gerstein, H. C., Miller, M. E., Byington, R. P., Goff, D. C., Bigger, J. T., Buse, J. B., ... &Friedewald, W. T. (2008). Effects of intensive glucose lowering in type 2 diabetes. New England Journal of Medicine, 358(24), 2545-2559. https://doi.org/10.1056/NEJMoa0802743
11. Holman, R. R., Paul, S. K., Bethel, M. A., Matthews, D. R., & Neil, H. A. (2008). 10-year follow-up of intensive glucose control in type 2 diabetes. New England Journal of Medicine, 359(15), 1577-1589. https://doi.org/10.1056/NEJMoa0806470
12. Klein, R., Klein, B. E., & Moss, S. E. (1998). Relation of glycemic control to diabetic complications and quality of life in type 1 diabetes. Diabetes Care, 21(8), 1233-1240. https://doi.org/10.2337/diacare.21.8.1233
13. Kumamoto Study Group. (1995). Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus. Diabetes Research and Clinical Practice, 28(2), 103-117. https://doi.org/10.1016/0168-8227(95)01039-K
14. Ohkubo, Y., Kishikawa, H., Araki, E., Miyata, T., Isami, S., Motoyoshi, S., ... &Shichiri, M. (1995). Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with NIDDM: A randomized prospective 6-year study. Diabetes Research and Clinical Practice, 28(2), 103-117. https://doi.org/10.1016/0168-8227(95)01039-K
15. Pfeiffer, A. F., & Klein, H. H. (2014). The treatment of type 2 diabetes. DtschArzteblInt, 111(5), 69-81. https://doi.org/10.3238/arztebl.2014.0069
16. Reichard, P., Nilsson, B. Y., &Rosenqvist, U. (1993). The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. New England Journal of Medicine, 329(5), 304-309. https://doi.org/10.1056/NEJM199307293290502
17. Stratton, I. M., Adler, A. I., Neil, H. A., Matthews, D. R., Manley, S. E., Cull, C. A., ... & Holman, R. R. (2000). Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes: Prospective observational study. BMJ, 321(7258), 405-412. https://doi.org/10.1136/bmj.321.7258.405
18. Turner, R. C., Millns, H., Neil, H. A., Stratton, I. M., Manley, S. E., Matthews, D. R., & Holman, R. R. (1998). Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: UK Prospective Diabetes Study (UKPDS 23). BMJ, 316(7134), 823-828. https://doi.org/10.1136/bmj.316.7134.823
19. UK Prospective Diabetes Study (UKPDS) Group. (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet, 352(9131), 837-853. https://doi.org/10.1016/S0140-6736(98)07019-6
20. UK Prospective Diabetes Study (UKPDS) Group. (1998). Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet, 352(9131), 854-865. https://doi.org/10.1016/S0140-6736(98)07037-8
21. Zoungas, S., Chalmers, J., Neal, B., Billot, L., Li, Q., Hirakawa, Y., ... & Patel, A. (2014). Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. New England Journal of Medicine, 371(15), 1392-1406. https://doi.org/10.1056/NEJMoa1407963
2. ADVANCE Collaborative Group. (2008). Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. New England Journal of Medicine, 358(24), 2560-2572. https://doi.org/10.1056/NEJMoa0802987
3. American Diabetes Association. (2022). Glycemic targets: Standards of medical care in diabetes—2022. Diabetes Care, 45(Suppl. 1), S83-S96. https://doi.org/10.2337/dc22-S006
4. Brown, J. B., Nichols, G. A., & Perry, A. (2004). The burden of treatment failure in type 2 diabetes. Diabetes Care, 27(7), 1535-1540. https://doi.org/10.2337/diacare.27.7.1535
5. Chalmers, J., & Cooper, M. E. (2008). UKPDS and the legacy effect. New England Journal of Medicine, 359(15), 1618-1620. https://doi.org/10.1056/NEJMe0807265
6. Diabetes Control and Complications Trial (DCCT) Research Group. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine, 329(14), 977-986. https://doi.org/10.1056/NEJM199309303291401
7. Duckworth, W., Abraira, C., Moritz, T., Reda, D., Emanuele, N., Reaven, P., ... & Huang, G. D. (2009). Glucose control and vascular complications in veterans with type 2 diabetes. New England Journal of Medicine, 360(2), 129-139. https://doi.org/10.1056/NEJMoa0808431
8. Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group. (2003). Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy. JAMA, 290(16), 2159-2167. https://doi.org/10.1001/jama.290.16.2159
9. Gaede, P., Vedel, P., Larsen, N., Jensen, G. V., Parving, H. H., & Pedersen, O. (2003). Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. New England Journal of Medicine, 348(5), 383-393. https://doi.org/10.1056/NEJMoa021778
10. Gerstein, H. C., Miller, M. E., Byington, R. P., Goff, D. C., Bigger, J. T., Buse, J. B., ... &Friedewald, W. T. (2008). Effects of intensive glucose lowering in type 2 diabetes. New England Journal of Medicine, 358(24), 2545-2559. https://doi.org/10.1056/NEJMoa0802743
11. Holman, R. R., Paul, S. K., Bethel, M. A., Matthews, D. R., & Neil, H. A. (2008). 10-year follow-up of intensive glucose control in type 2 diabetes. New England Journal of Medicine, 359(15), 1577-1589. https://doi.org/10.1056/NEJMoa0806470
12. Klein, R., Klein, B. E., & Moss, S. E. (1998). Relation of glycemic control to diabetic complications and quality of life in type 1 diabetes. Diabetes Care, 21(8), 1233-1240. https://doi.org/10.2337/diacare.21.8.1233
13. Kumamoto Study Group. (1995). Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus. Diabetes Research and Clinical Practice, 28(2), 103-117. https://doi.org/10.1016/0168-8227(95)01039-K
14. Ohkubo, Y., Kishikawa, H., Araki, E., Miyata, T., Isami, S., Motoyoshi, S., ... &Shichiri, M. (1995). Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with NIDDM: A randomized prospective 6-year study. Diabetes Research and Clinical Practice, 28(2), 103-117. https://doi.org/10.1016/0168-8227(95)01039-K
15. Pfeiffer, A. F., & Klein, H. H. (2014). The treatment of type 2 diabetes. DtschArzteblInt, 111(5), 69-81. https://doi.org/10.3238/arztebl.2014.0069
16. Reichard, P., Nilsson, B. Y., &Rosenqvist, U. (1993). The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. New England Journal of Medicine, 329(5), 304-309. https://doi.org/10.1056/NEJM199307293290502
17. Stratton, I. M., Adler, A. I., Neil, H. A., Matthews, D. R., Manley, S. E., Cull, C. A., ... & Holman, R. R. (2000). Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes: Prospective observational study. BMJ, 321(7258), 405-412. https://doi.org/10.1136/bmj.321.7258.405
18. Turner, R. C., Millns, H., Neil, H. A., Stratton, I. M., Manley, S. E., Matthews, D. R., & Holman, R. R. (1998). Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: UK Prospective Diabetes Study (UKPDS 23). BMJ, 316(7134), 823-828. https://doi.org/10.1136/bmj.316.7134.823
19. UK Prospective Diabetes Study (UKPDS) Group. (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet, 352(9131), 837-853. https://doi.org/10.1016/S0140-6736(98)07019-6
20. UK Prospective Diabetes Study (UKPDS) Group. (1998). Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet, 352(9131), 854-865. https://doi.org/10.1016/S0140-6736(98)07037-8
21. Zoungas, S., Chalmers, J., Neal, B., Billot, L., Li, Q., Hirakawa, Y., ... & Patel, A. (2014). Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. New England Journal of Medicine, 371(15), 1392-1406. https://doi.org/10.1056/NEJMoa1407963
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Published
Mar 13, 2025
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How to Cite
Amir Ibrahim Almasri, Mohammed Ali Yassin Malallah, Noor Sarchanar Jamal, Yusur Ahmed Al-Sudani, Fatima Ziad Zain Albedin, Dr Yasser Talal, Aida Emara, Dr Abdulrahman Majdi, Zain Husam Haddad, Noor Ayman Khalil Salim Nawas Abukhater, & Shafa Thekkekara. (2025). THE CRITICAL ROLE OF EARLY GLYCEMIC CONTROL IN PREVENTING LONG-TERM MICROVASCULAR AND MACROVASCULAR COMPLICATIONS IN DIABETES. Journal of Population Therapeutics and Clinical Pharmacology, 32(2), 339-347. https://doi.org/10.53555/v2x2b216
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Author Biographies
Amir Ibrahim Almasri
University of Sharjah, UAE
Mohammed Ali Yassin Malallah
University of Sharjah, UAE
Noor Sarchanar Jamal
University of Sharjah, UAE
Yusur Ahmed Al-Sudani
University of Sharjah, UAE
Fatima Ziad Zain Albedin
University of Sharjah, UAE
Dr Yasser Talal
NMC Royal Khalifa, Abu Dhabi, UAE
Aida Emara
Health Education, North East England
Dr Abdulrahman Majdi
NMC Royal Khalifa, Abu Dhabi, UAE
Zain Husam Haddad
University of Sharjah, UAE
Noor Ayman Khalil Salim Nawas Abukhater
Thumbay University Hospital, Ajman, UAE
Shafa Thekkekara
MBBS Graduate from Rak Medical and Health Sciences University (RAKMHSU), UAE Teaching Assistant in the Pediatrics, Department at Rakmhsu, UAE
How to Cite
Amir Ibrahim Almasri, Mohammed Ali Yassin Malallah, Noor Sarchanar Jamal, Yusur Ahmed Al-Sudani, Fatima Ziad Zain Albedin, Dr Yasser Talal, Aida Emara, Dr Abdulrahman Majdi, Zain Husam Haddad, Noor Ayman Khalil Salim Nawas Abukhater, & Shafa Thekkekara. (2025). THE CRITICAL ROLE OF EARLY GLYCEMIC CONTROL IN PREVENTING LONG-TERM MICROVASCULAR AND MACROVASCULAR COMPLICATIONS IN DIABETES. Journal of Population Therapeutics and Clinical Pharmacology, 32(2), 339-347. https://doi.org/10.53555/v2x2b216