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Whether diabetic nephropathy will finally increase and “catch up” in the former intensive-therapy patients in the event that they proceed with their presently larger imply levels of HbA1c is unknown. Both hypertension and diabetes must be diagnosed early and handled aggressively to stop associated microvascular and macrovascular morbidity and mortality.7-11 The UK Prospective Diabetes Study showed that blood pressure management helps to keep away from cardiovascular complications in patients with sort 2 diabetes:12,thirteen each 10 mmHg decrease in mean systolic blood pressure was related to 12% discount in the risk for any complication related to diabetes, 15% reduction in deaths associated to diabetes, 11% reduction in myocardial infarction, and 13% discount in microvascular complications. The entry level of HbAlc at DCCT baseline was recognized as a threat factor for the next development of retinopathy through the DCCT.12 Moreover, although the imply HbAlc levels of the 2 DCCT therapy groups reached their maximum separation by 6 months postrandomization, it took three to 4 years of different remedy regimens with separation of HbAlc ranges by 2.0%, earlier than the cumulative incidence curves of retinopathy and nephropathy in the intensive remedy and typical remedy groups started to diverge distinctly (Figure 1).9 In the case of retinopathy, this delay might partly be accounted for by the phenomenon of early worsening that occurred throughout the first 6 to 12 months of intensive therapy in 13% of the DCCT patients.21 These findings indicate that hyperglycemia has lengthy-term chronic effects on the underlying pathophysiolgy of microvascular complications, not acute effects.
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