Management of both Type 1 Diabetes (T1DM) and Type 2 Diabetes (T2DM) involves careful monitoring and treatment of hypertension, hyperlipidaemia and hyperglycaemia. Aggressive treatment of high blood pressure and high cholesterol has proven effective in reducing mortality in both T1DM and T2DM. Various guidelines suggest cut-off values for blood pressure and cholesterol. These cut-off values have been pushed downwards constantly during the last three decades. Some have argued that a lower limit exist from where a further reduction will not be beneficial or even harmful (the J-curve phenomenon). Recent prospective studies indicate that this phenomenon exists in specific patient groups regarding antihypertensive therapy. A downside to the more and more standardized clinical care of T2DM is the widespread tendency to treat all patients in accordance with one set of clinical recommendations. The rather huge variations in the phenotype of T2DM suggest a more differentiated approach to treatment.In our clinical research we take part in a national effort to build a big database and associated biobank.
The association between glycaemic control and the development of microangiopathy has been known for many years, and prospective studies have proven glycaemic intervention to be effective. The clinical problem deals with the delicate balance between avoiding prolonged hyperglycaemia leading to late complications (Scylla) and hypoglycaemia threatening life and the well-being of the patients (Charybdis). During the last two decades the development of sensors for continuous glucose monitoring has made considerable technical progress. The technical progress has been focusing on size, convenience and reproducibility. The progress has been reported in terms of accuracy and precision and the number of error-grid-analyses have been exhausting. The real barrier today for widespread clinical use of the present reasonably accurate and precise technology is (apart from financial constraints) durability, practicability and reliability. The next technical advances will need to focus on ease-of-use (for patients and staff). The department is deeply involved in this type of practical research.
Contacts
Per Løgstrup Poulsen, MD, DMSci, perpouls@rm.dk