ARE THERE ANY GLYCEMIC THRESHOLDS FOR THE SERIOUS MICROVASCULAR DIABETIC COMPLICATIONS

We randomized 102 patients with insulin-dependent diabetes to intensif ied treatment (n = 48 at baseline, n = 42 after 7.5 years) or standard treatment (n = 54 at baseline, n = 47 after 7.5 years). As has previo usly been reported, intensified treatment resulted in a retardation of retinopathy, nephropathy, and neuropathy. For the purpose of the pres ent study, all patients were analyzed, and the complications related t o the mean glycosylated hemoglobin (HbA(1c)) level. Patients with mild retinopathy at onset did not develop serious retinopathy, visual dete rioration, or manifest nephropathy if their mean HbA(1c) during 7.5 ye ars was below 7% (normal range, 3.9%-5.7%). Neuropathy only rarely dev eloped in patients with HbA(1c) below 7%. Visual acuity in the patient group with more advanced retinopathy at baseline was also better pres erved if the patient had lower HbA(1c); also whereas these patients ne eded photocoagulation treatment just as often as the patients with hig her HbA(1c) because of proliferative retinopathy or sight-threatening macular edema. The risk for the development of serious and disabling m icrovascular complications seems to be small in patients with insulin- dependent diabetes mellitus if they start intensified treatment when t hey have mild retinopathy, and achieve mean HbA(1c) levels below 7% (1 .2 times the upper normal limit).