Preventing all the complications of hyperglycaemia: not a straightforward task

Aidan McElduff
Med J Aust 2016; 205 (4): . || doi: 10.5694/mja16.00726
Published online: 15 August 2016

Individualised multifactorial treatment strategies are required to optimise outcomes

Epidemiological studies have found positive relationships between measures of glycaemia and adverse fetal and maternal pregnancy outcomes,1 macrovascular disease2,3 and the microvascular complications of diabetes.2,3 The relationship between glycaemia and microvascular disease is more complicated, as there is an inflection point below which the risk is very low, but beyond which it rises sharply. The inflection point of the relationship between glycaemia values and the prevalence of retinopathy has been used to determine both the glucose tolerance test values and the glycated haemoglobin (HbA1c) level used to diagnose diabetes (see Figure 1 in reference 3).

  • University of Sydney, Sydney, NSW

Competing interests:

No relevant disclosures.

  • 1. HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. Diabetes 2009; 58: 453-459.
  • 2. Stratton IM, Adler AI, Neil AW, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321: 405-412.
  • 3. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009; 32: 1327-1334.
  • 4. Catalano PM, McIntyre HD, Cruickshank JK, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care 2012 35: 780-786.
  • 5. Badon SE, Dyer AR, Josefson JL. Gestational weight gain and neonatal adiposity in the Hyperglycemia and Adverse Pregnancy Outcome study — North American region. Obesity (Silver Spring) 2014; 22: 1731-1738.
  • 6. Stamler J, Vaccaro O, Neaton JD, Wentworth D; for the Multiple Risk Factor Intervention Trial Research Group. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993; 16: 434-444.
  • 7. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703.
  • 8. National Eye Institute. Facts about diabetic eye disease [website]. Updated Sept 2015. (accessed June 2016).
  • 9. Abell SK, Boyle JA, de Courten B, et al. Contemporary type 1 diabetes pregnancy outcomes: impact of obesity and glycaemic control. Med J Aust 2016; 205: 162-167.
  • 10. Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359: 1577-1589.
  • 11. Nathan DM; for the DCCT/EDIC Research Group. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study at 30 years: overview. Diabetes Care 2014; 37: 9-16.
  • 12. The ACCORD Study Group. Nine-year effects of 3.7 years of intensive glycemic control on cardiovascular outcomes. Diabetes Care 2016; 39: 701-708.
  • 13. Gaede P, Lund-Andersen H, Parving HH, et al. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008; 358: 580-591.
  • 14. Cheung WH, Conn JJ, d’Emden MC, et al. Position statement of the Australian Diabetes Society: individualisation of glycated haemoglobin targets for adults with diabetes mellitus. Med J Aust 2009; 191: 339-344. <MJA full text>


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.