Controlling blood glucose levels in patients with type 2 diabetes mellitus- An evidence-based policy statement by the American Academy of Family Physicians and American Diabetes Association

OBJECTIVE To review evidence about the benefit of intensive glycemic contro l for patients with typo 2 diabetes and to develop practice recommendations . PARTICIPANTS A 9-member panel composed of family physicians, general intern ists, endocrinologists, and a practice guidelines methodologist was assembl ed by the American Academy of Family Physicians, the American Diabetes Asso ciation, and the American College of Physicians. EVIDENCE Admissible evidence included published randomized controlled trial s and observational studies regarding the effects of glycemic control on mi crovascular and macrovascular complications and on adverse effects. We foll owed systematic search and data abstraction procedures. Greater weight was given to clinical trials and to evidence about health outcomes. CONSENSUS PROCESS Interpretations of evidence and approval of documents wer e finalized by unanimous vote, with recommendations linked to evidence and not export opinion. The full report was prepared by the chair and 2 panel m embers, representing each of the 3 organizations. The initial draft underwe nt external review by 14 diabetologists and family physicians and changes c onsistent with the evidence were incorporated. CONCLUSIONS The evidence demonstrates that the risk of microvascular and ne uropathic complications is reduced by lowering glucose concentrations. Whet her glycemic control affects macrovascular outcomes is less clear. The pote ntial benefits of glycemic control must be balanced against factors that ei ther preempt benefits (eg, limited life expectancy, comorbid disease) or in crease risk (eg, severe hypoglycemia). The magnitude of benefit is 3 functi on of individual clinical variables (eg, baseline glycated hemoglobin level , presence of preexisting microvascular disease). Appropriate rat-gets for treatment should be determined by considering these factors, patients' risk profiles, and personal preferences.