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«  Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes . SFD Congress -Geneva Reported by Dr Ramona Abi Gerges. Publications :. N Engl J Med 2011; 364:818-28 N Engl J Med 2003; 348:383-93 N Engl J Med 2011 ;364:829-41

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should we reconsider our therapeutic goals in 2011 pr bernard charbonnel nantes

« Shouldwereconsiderourtherapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes

SFD Congress-Geneva

Reported by

Dr Ramona AbiGerges

publications
Publications :
  • N Engl J Med 2011;364:818-28
  • N Engl J Med 2003;348:383-93
  • N Engl J Med 2011;364:829-41
  • The Lancet 2010, vol.375,issue 9713, Pages 481 - 489
  • Diabetes Care 2010,April 28 vol. 33 no. 5 983-990
  • Diabetologia 2010, 53:2079–2085
  • Diabetologia 2009,52:2288–2298
  • BMJ 2010; 340:b5444
  • BMJ 2000; 321:405-12
  • Annals of Internal Medicine 2009, Vol.151 • Nbr 6-396
slide3

No epidemiologic argument in favor of poor glycemic control

  • Paradoxical results in ACCORD showed that mortality increases when

HBA1C<6% and >8%

  • UKPDS: reduction in micro-vascular , microalbuminuria complications when HBA1C<8%
slide4

Reasonsfor increased mortality

  • Rapiddecrease in HBA1c ?
  • Severehypoglycemia ?
  • Uncontrolledhyperglycemiaitself?
  • Drug interactions, polymedications?
diabetes care doi 10 2337 dc09 1278

EpidemiologicRelationshipsBetween A1C and All-Cause MortalityDuring a Median 3.4-YearFollow-up of GlycemicTreatment in the ACCORD Trial

Diabetes Care doi: 10.2337/dc09-1278

conclusion
Conclusion
  • Hba1c is a marker of risk of complication
  • Hypoglycemia is a marker of risk of mortality rather than reason
  • The objective of the treatment is not to bring down HBA1C but to prevent complications micro and macro-vascular, irreversible once installed
conclusion1
Conclusion
  • The target HbA1c varies between 6,5 % and 8 % according to the patients
  • The individualization of the therapeutic way remains the best daily approach in our clinical practice
  • « Earlier?Probably» « More extremely?Probably not »