A group of clinical assessments is defined for optimal diabetes can Specific goals of therapy are linked to these assessments and, in general are based on evidence from randomized collaborative therapeutic trials. These assessments are described below, with brief reviews of the evidence in support of their use.
Glucose
Experiences from the DCCT are examples of the evidence-based background that supports intensive management of type 1 diabetes. This landmark study demonstrated that intensive therapy aimed at achieving glycemic control as close to normal as possible reduced the development and progression of retinopathy, albuminuria, and neuropath compared with conventional therapy. The findings of this randomize trial are extended and supported by epidemiologic studies of the level of glycemic exposure before and during the DCCT with the risk of progression of the primary endpoint, retinopathy.
Total glycemic exposure emerged as the dominant factor defining the risk of development and progression of retinopathy in the DCCT. The shorter the duration of type 1 diabetes at entry into the trial and the low the baseline HbAlc value, the greater the benefits of intensive therapy] Within each treatment group, the mean HbAlc during the trial was th’ dominant predictor of retinopathy progression.
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