2,46 Mb - GuíaSalud

[RR 0.75 (CI 95%: 0.60-0.93)], and in particular, due to the reduction of photocoagulation.
Likewise, an insignificant tendency in the decrease of other events,
such as AMI or amputations, was observed. The main adverse effect found was
the imperative increase of severe hypoglycaemia stages; this is one of the reasons
why glycemic aims must be individualised. Only 50% of the patients assigned to
the intensive treatment, achieved figures below 7%.
Therefore the HbA 1
c targets have to take into consideration the benefits of
intensive control as regards the risk of hypoglycaemia, and the incovenience of
the treatment for the patient and his family. The guidelines examined agree on the
importance of glycemic targets for HbA 1
c between 6.5% and 7.5% mainly based
on the aforementioned studies. An edition was issued recently on this matter in
the main CPGs on diabetes (107). The authors state that targets below 7% for
HbA 1
c are considered reasonable for many patients, though not for all. The target
for the HbA 1
c level should be based on the individualised assessment of the risk
for diabetes complications, comorbidity, life style and the patient’s preferences.
The aims of the treatment should be set after having debated with the patient on
the advantages and the risks of the specific levels of glycemic control. In general,
lower HbA 1
c figures are recommended for patients with microalbuminuria within
the context of a multifactorial intervention to reduce cardiovascular risk (108).
Likewise, less strict levels can be appropriate for patients with limited life expectancy,
comorbidity or a prior hypoglycaemia history (2).
Recently, the ACCORD trial has compared strict glycemic control (HbA 1
c