Summary
The controversy over whether strict blood glucose control prevents or attenuates the complications of diabetes is still unresolved, but the available data support the value of good blood glucose control. The resolution of the controversy is not feasible at present because of the complexity and financial cost of a definitive prospective study and because we may not presently possess pharmacological agents which can accomplish the goal of long term strict control of the blood glucose. Finally, whereas we regard retinopathy, nephropathy and neuropathy as valid pathological endpoints, we are not secure in assuming that blood glucose represents the critical measurement for longitudinal assessment of metabolic control. Studies evaluating control based on blood and urine glucose assessments are complicated by the failure of the data to reflect changes in minute to minute regulation. Thus, the relative insensitivity of some of these parameters of control could account for failures to demonstrate a correlation between adequacy of therapy and diabetic complications.
Similar content being viewed by others
References
Bennion, L.J. and Grundy, S.M.: Influence of diabetic control on cholesterol metabolism in man. Diabetes 25(Suppl. 1): 324 (1976).
Bloodworth, J.M.B.: Experimental diabetic glomerulosclerosis II. The dog. Archives of Pathology 79: 113 (1965).
Bondy, P.K. and Felig, P.: Relation of diabetic control to development of vascular complications. Medical Clinics of North America 55: 889 (1971).
Bressler, R.: The controversy over blood glucose control. Drug Therapy 8: 24 (1978).
Brownlee, M.: Normoglycemia as a therapeutic goal in insulin-dependent diabetes. Drug Therapy (Hospital Ed) 3: 13 (1978).
Bunn, H.F.; Haney, D.N.; Gabbay, H.K. and Gallop, P.M.: Further identification of the nature and linkage of the carbohydrate in hemoglobin AIC. Biochemical and Biophysical Research Communications 67: 103 (1975).
Bunn, H.F.; Haney, D.N.; Kamin, S. and Gabbay, K.H.: The biosynthesis of human hemoglobin AIC. Slow glycosylatin of hemoglobin in vivo. Journal of Clinical Investigation 57: 1652 (1976).
Cahill, G.F.; Etzwiler, D.D. and Freinkel, N.: “Control” and diabetes. New England Journal of Medicine 294: 1004 (1976).
Clements, R.S.: Personal Communication.
Clements, R.S.; Reynertson, R.H. and Starnes, W.R.: Myoinositol metabolism in diabetes mellitus. Diabetes 23(Suppl. 1): 348 (1974).
Danowski, T.S.; Fisher, E.R.; Khurana, R.C.; Nolan, S. and Stephan, T.: Muscle capillary basement membrane in juvenile diabetes mellitus. Metabolism 21: 1125 (1972).
Danowski, T.S. and Sunder, J.H.: Jet injection of insulin during self-monitoring of blood glucose. Diabetic Care 1: 27 (1978).
Dolger, H.: Clinical evaluation of vascular damage in diabetes mellitus. Journal of the American Medical Association 134: 1289 (1947).
Downie, E.: Vascular disease in juvenile diabetic patients of long duration. Diabetes 8: 383 (1959).
Engerman, R.; Bloodworth, J.M.B. and Nelson, S.: Relationship of microvascular disease in diabetes to metabolic control. Diabetes 26: 760 (1977).
Fukuda, M.: Blood fibrinolytic activity and fibrinogen concentration in diabetic retinopathy. Eye, Ear, Nose and Throat Monthly 51: 266 (1972).
Goldner, M.G.; Knatterud, G.L. and Prout, T.E.: A study of effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes. III. Clinical implications of UGDP results. Journal of the American Medical Association 218: 1400 (1971).
Goodkin, G.: Mortality factors in diabetes: A 20 year mortality study. Occupational Medicine 17: 716 (1975).
Greene, D.A.; Pacifico, V.D.J. and Winegrad, A.I.: Effects of insulin and dietary myoinositol on impaired peripheral nerve conduction velocity in acute streptozotocin diabetes. Journal of Clinical Investigation 55: 1326 (1975).
Gregersen, G.: Diabetic neuropathy, influence of age, sex, metabolic control and duration of diabetes on motor conduction velocity. Neurology 17: 972 (1967).
Haloshka, P.V.; Lurie, D. and Colwell, J.A.: Increased synthesis of prostaglandin-E-like material by platelets from patients with diabetes mellitus. New England Journal of Medicine 297: 1306 (1977).
Hardin, R.C., Jackson, R.L.; Johnston, T.L. and Kelly, H.G.: The development of diabetic retinopathy. The effects of duration and control of diabetes. Diabetes 5: 397 (1956).
Jackson, R.; Guthrie, R.; Esterly, J.; Bilginturan, N.; James, R.; Yeast, J.; Saathoff, J. and Guthrie, D.: Muscle capillary basement membrane changes in normal and diabetic children. Diabetes 24(Suppl. 2): 400 (1975).
Job, D.; Eschwege, E.; Guyot-Argenton, C.; Aubry, S.P. and Tchobroutsky, G.: Effect of multiple daily insulin injection on the cause of retinopathy. Diabetes 25: 463 (1976).
Johnsson, S.: Retinopathy and nephropathy in diabetes mellitus: Comparison of the effect of two forms of treatment. Diabetes 9: 1 (1960).
Kaplan, M.H. and Feinstein, A.R.: A critique of methods in reported studies of long-term vascular complications in patients with diabetes mellitus. Diabetes 22: 160 (1973).
Keiding, N.R.; Root, H.F. and Marble, A.: Importance of control of diabetes in prevention of vascular complications. Journal of the American Medical Association 150: 964 (1952).
Kilo, C.; Vogler, N. and Williamson, J.R.: Muscle capillary basement membrane changes related to aging and diabetes mellitus. Diabetes 21: 881 (1972).
Knowles, H.C.; Guest, G.M.; Lampe, J.; Kessler, M. and Skillman, T.G.: The course of juvenile diabetes treated with unmeasured diet. Diabetes 14: 239 (1965).
Koenig, R.J. and Cerami, A.: Synthesis of hemoglobin AIC in normal and diabetic mice: potential model of basement membrane thickening. Proceedings of the National Academy of Science 72: 3687 (1975).
Koenig, R.J.; Peterson, C.M.; Kilo, C. and Cerami, A.: Hemoglobin AIC as an indicator of the degree of glucose intolerance in diabetes. Diabetes 25: 230 (1976a).
Koenig, R.J.; Peterson, C.M.; Jones, R.L. and Saudek, C.: Correlation of glucose regulation and hemoglobin AIC in diabetes mellitus. New England Journal of Medicine 295: 417 (1976b).
Koenig, R.J.; Araujo, D.C. and Cerami, A.: Increased hemoglobin AIC in diabetic mice. Diabetes 25: 1 (1976c).
Kohner, E.M.; Fraser, T.R.; Joplin, G.F. and Oakley, N.W.: The effect of diabetic control on diabetic retinopathy; in Goldberg and Fine (Eds) Symposium on the Treatment of Diabetic Retinopathy, p.119 (US Government Printing Office, Washington, D.C. 1968).
Lee, C.S.; Mauer, S.M.; Brown, D.M. and David, E.R.: Renal transplantations in diabetes mellitus in rats. Journal of Experimental Medicine 139: 793 (1974).
Mauer, S.M.; Michael, A.F.; Fish, A.J. and Brown, D.M.: Spontaneous immunoglobulin and complement deposition in glomeruli of diabetic rats. Laboratory Investment 27: 488 (1972).
Mauer, S.M.; Steffes, M.W.; Sutherland, D.E.R. and Najarian, J.S.: Studies of the rate of regression of the glomerular lesions in diabetic rats treated with pancreatic islet transplantation. Diabetes 24: 280 (1975).
Mauer, S.M.; Barbosa, J.; Vernier, R.L. and Kjellstrand, C.M.: Development of diabetic vascular lesions in normal kidneys transplanted into patients with diabetes mellitus. New England Journal of Medicine 295: 916 (1976a).
Mauer, S.M.; Miller, K.; Goetz, F.C. and Barbosa, J.: Immunopathology of renal extracellular membranes in kidneys transplanted into patients with diabetes mellitus. Diabetes 25: 709 (1976b).
Miki, E.; Fukuda, M.; Kuzuya, T.; Kosaka, K. and Nakao, K.: Relation of course of retinopathy to control of diabetes, age and therapeutic agents in diabetic Japanese patients. Diabetes 18: 773 (1969).
Miki, E.; Kuzuya, T.; Ide, T. and Nakao, K.: Frequency, degree and progression with time of proteinuria in diabetic patients. Lancet 1: 922 (1972).
Miller, K. and Michael, A.F.: Immunopathology of renal extracellular membranes in diabetes mellitus. Specificity of tubular basement membrane immunofluorescence. Diabetes 25: 701 (1976).
Molnar, G.; Taylor, W. and Langworthy, A.: Plasma immunoreactive insulin pattern in insulin-treated diabetes. Mayo Clinical Proceedings 47: 709 (1972).
Oakley, W.G.; Pyke, D.A., Tattersall, R.B. and Watkins, P.J.: Long-term diabetes: A clinical study of 92 patients after 40 years. Quarterly Journal of Medicine 43: 145 (1974).
Osterby, R.: Early phases in the development of diabetic glomerulopathy. Acta Medica Scandinavica Supplement 574: 1 (1974).
Pardo, V.; Perez-Stable, E.; Alzamora, D.B. and Cleveland, W.W.: Incidence and significance of muscle capillary basal lumina thickness in juvenile diabetes. American Journal of Pathology 68: 67 (1972).
Paul, S.D. and Adlakha, D.D.: Fibrinolytic activity in ocular diseases. Ophthalmologica 148: 374 (1964).
Paulsen, E.P. and Kowry, W.: Hemoglobin AIC in insulin-dependent and independent diabetes mellitus. Diabetes 25(Suppl. 2): 890 (1976).
Peterson, C.M.; Jones, R.L.; Koenig, R.J.; Melvin, E.T. and Lehrman, M.L.: Reversible hematologic sequelae of diabetes mellitus. Annual Internal Medicine 86: 425 (1977).
Pirart, J.: Diabetes mellitus and its complications: A prospective study of 4400 patients observed between 1947 and 1973. Diabetic Care 1: 168 (1978).
Preston, F.E.; Marcola, B.H.; Ward, J.D.; Porter, N.R.; Timperley, W.R. and O’Malley, B.C.: Elevated β-thromboglobulin levels and circulating platelet aggregates in diabetic microangiopathy. Lancet 1: 238 (1978).
Rahbar, S.: An abnormal hemoglobin in red cells of diabetes. Clinica Chimica Acta 22: 296 (1968).
Raskin, P.: Diabetic regulation and its relationship to microangiopathy. Metabolism 27: 235 (1978).
Ryan, J.R.; Balodimos, M.C.; Chazan, B.I.; Root, H.F.; Marble, A.; White, P. and Joslin, A.P.: Quarter century victory medal for diabetes: A follow-up of patients one to 20 years later. Metabolism 19: 493 (1970).
Siperstein, M.D.; Raskin, R. and Burns, H.: Electron microscopic quantification of diabetic microangiopathy. Diabetes 22: 514 (1973).
Siperstein, M.D.; Foster, D.W.; Knowles, H.C. Jr.; Levine, R.; Madison, L.L. and Roth, J.: Control of blood glucose and diabetic vascular disease. New England Journal of Medicine 296: 1060 (1977).
Sonksen, P.H.; Judd, S.L. and Lowy, C.: Home monitoring of blood glucose. Lancet 1: 729 (1978).
Takazakura, E.; Nakamoto, Y.; Hayakawa, H.; Kawai, K.; Muramoto, S.; Yoshida, K.; Shimizu, M.; Shinoda, H. and Takeuchi, J.: Onset and progression of diabetic glomerulosclerosis: A prospective study based on serial renal biopsies. Diabetes 24: 1 (1975).
Tattersal, R.B.; Pyke, D.A.; Ranney, H.M. and Bruckheimer, S.M.: Hemoglobin components in diabetes mellitus. Studies in identical twins. New England Journal of Medicine 293: 1171 (1975).
Walford, S.; Allison, S.P.; Gale, E.A.M. and Tattersal, R.B.: Self-monitoring of blood glucose. Lancet 1: 732 (1978).
Williamson, J.R.; Rowold, E.; Hoofman, P. and Kolo, C.: Influence of fixation and morphometric technics on capillary basement membrane thickening prevalence data in diabetes. Diabetes 25: 604 (1976).
Winegrad, A.I. and Greene, D.A.: Diabetic polyneuropathy: The importance of insulin deficiency, hyperglycemia and alterations in myoinositol metabolism in its pathogenesis. New England Journal of Medicine 295: 1416 (1975).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bressler, R. Control of the Blood Glucose in Diabetes Mellitus: Is it Valuable? Is it Feasible?. Drugs 17, 461–470 (1979). https://doi.org/10.2165/00003495-197917060-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-197917060-00002