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«  Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes

«  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

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  1. « Shouldwereconsiderourtherapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes SFD Congress-Geneva Reported by Dr Ramona AbiGerges

  2. 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

  3. 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%

  4. Reasonsfor increased mortality • Rapiddecrease in HBA1c ? • Severehypoglycemia ? • Uncontrolledhyperglycemiaitself? • Drug interactions, polymedications?

  5. 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

  6. 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

  7. 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 »

  8. Thank you

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