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Microvascular Complications Associated With Rapid Improvements in Glycemic Control in Diabetes

  • Lifestyle Management to Reduce Diabetes/Cardiovascular Risk (B Conway and H Keenan, Section Editors)
  • Published:
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Abstract

Purpose of Review

Aggressive glycemic control has become the standard clinical approach to diabetes care. Unintended consequences have included the development of microvascular complications that are related to the rapidity of glycemic improvement.

Recent Findings

Diabetic neuropathy may develop in up to 10% of individuals secondary to aggressive glycemic control. The neuropathy is predominantly small fiber sensory and autonomic, and the severity of the neuropathy is tied to the change in the glycosylated hemoglobin A1C. Other microvascular complications such as retinopathy and nephropathy are common and may occur in parallel with the neuropathy. Eating disorders are a common comorbid risk factor.

Summary

Individuals with uncontrolled diabetes for prolonged periods, particularly those with a history of eating disorders involving insulin restriction for calorie purging, are at high risk for developing treatment-induced microvascular complications. Gradual glycemic improvements should be encouraged but future research is needed to optimize treatment and prevention strategies.

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Author information

Authors and Affiliations

  1. Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Palmer 111, Boston, MA, 02215, USA

    Christopher H. Gibbons

  2. 1101 Beacon St. 8W, Brookline, MA, 02446, USA

    Ann Goebel-Fabbri

Authors
  1. Christopher H. Gibbons
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  2. Ann Goebel-Fabbri
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Corresponding author

Correspondence to Christopher H. Gibbons.

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Conflict of Interest

Christopher H. Gibbons has received research funding from Celgene and Grifols, and has served on advisory boards for Lundbeck and Pfizer, and served on data safety monitoring boards of Janssen and Astellas.

Ann Goebel-Fabbri declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Lifestyle Management to Reduce Diabetes/Cardiovascular Risk

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Gibbons, C.H., Goebel-Fabbri, A. Microvascular Complications Associated With Rapid Improvements in Glycemic Control in Diabetes. Curr Diab Rep 17, 48 (2017). https://doi.org/10.1007/s11892-017-0880-5

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  • DOI: https://doi.org/10.1007/s11892-017-0880-5

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