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This slide
summarizes these findings where epidemiology has lead us in terms of prevention. Clearly
glycemic control is vitally important for the prevention of microvascular complications
and the ADA goal of 8% is a perfectly reasonable goal to achieve for all diabetics. How
far one pushes below 8% towards the normal 6%, is partly dependent on the age and overall
risk factor profile of the diabetic subject. Vigorous attempts to keep the blood sugar
below 6% in the elderly may be disadvantageous as they are unlikely to survive long enough
to develop the microvascular complications. On the other hand, a young Type 2 diabetic
developing diabetes in their late 40s or early 50s microvascular glycemic
control would be relatively more important. However, in addition to glycemic control, ACE
inhibition and vigorous cholesterol lowering for CHD in Type 2 diabetes is also strongly
advocated as indicated. Trials underway will hopefully provide answers in terms of
cholesterol lowering for the primary prevention of macrovascular events. |