Importance of Glycemic Control in Diabetes

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Based on the Diabetes Control and Complications Trial data in type-1 diabetes [27], it was considered that improved glycemic control would help in the prevention of diabetes-associated complications [28]. This view has been confirmed by the results of the UK Prospective Diabetes Study in type-2 diabetes [19]. Loss of excess body weight continues to be a goal for patients with type-2 diabetes to improve blood glucose control and serum lipid profiles. Furthermore, in view of the threefold to fourfold increased risk of CHD that accompanies diabetes mellitus, additional strategies are sought to normalize a constellation of CHD risk factors (table 2), including serum lipids.

Recently the American Diabetes Association (ADA) stated that the 'regulation of blood glucose to achieve near-normal levels is a primary goal in the management of diabetes, and, thus, dietary techniques that limit hyper-glycemia following a meal are likely important in limiting the complications of diabetes' [29]. The ADA added that 'a recent analysis of the randomized controlled trials that have examined the efficacy of the glycemic index on overall blood glucose control indicates that the use of this technique can provide an additional benefit over that observed when total carbohydrate is considered alone' [29]. However, with reference to the glycemic index, the ADA concluded that 'the relationship between glycemic index and glycemic load and the development of type-2 diabetes remains unclear at this time' [29]. So while there is general agreement on the importance of glycemic control in controlling diabetes and preventing its associated complications and some recognition of the importance of controlling postprandial hyperglycemia, the glycemic index concept remains of interest but is at present not fully accepted.

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