3.3.0.0 Treat­ment

3.3.1.0 Glyce­mic Con­trol

Near-‍nor­mal glycemic con­trol, im­ple­ment­ed early in the course of di­a­betes, has been shown to ef­fectively delay or pre­vent the de­vel­op­ment of DPN and CAN in pa­tients with type 1 di­a­betes (112-115). Al­though the ev­i­dence for the benefit of near-‍nor­mal glycemic con­trol is not as strong for type 2 di­a­betes, some stud­ies have demon­strated a mod­est slow­ing of pro­gres­sion with­out re­ver­sal of neu­ronal loss (32,116). Specific glu­cose-low­er­ing strate­gies may have dif­fer­ent ef­fects. In a post hoc anal­y­sis, par­tic­i­pants, par­tic­u­larly men, in the By­pass An­gio­plas­ty Revas­cu­larization In­ves­ti­ga­tion in Type 2 Di­a­betes (BARI 2D) trial treat­ed with in­sulin sen­si­tiz­ers had a lower in­ci­dence of dis­tal sym­met­ric polyneu­ropa­thy over 4 years than those treat­ed with in­sulin/sulfonylurea (117).