Glucose control in diabetes.

Diabetes is a worldwide disease. Epidemiological data indicates that the degree and duration of hyperglycaemia is associated with the microvascular and macrovascular complications of disease. Glycated haemoglobin at baseline is a significant predictor of retinopathy, as well as proteinuria, amputation and survival. Intensive blood glucose control with either sulphonylureas, metformin or insulin substantially decreases the risk of microvascular complications. There are no thresholds within the diabetic range of blood glucose for risk of microvascular complications. To reduce risk, we should aim for normal blood glucose levels. Mortality correlates with several parameters of glucose control, but notably with the coefficient of variation of fasting glucose, a marker of glucose instability. Postprandial hyperglycaemia is also another independent risk factor for atherosclerosis. Glucose sensors have considerable potential for monitoring changes in blood glucose concentration. Protein glycation is widespread and glycation of haemoglobin (HbA1c) probably reflects level of glycation of other proteins. Levels of advanced glycation end products could be valuable in assessing the risk of progression to diabetic complications. The fact that a glycated protein, the glycated haemoglobin, is now widely used to estimate glucose control in diabetes emphasizes the importance of the impact of ambient blood glucose on protein levels, structure and function on the clinical outcome of diabetes. Copyright 2004 John Wiley & Sons, Ltd.