Epidemiology of late diabetic complications. A basis for the development and evaluation of preventive programs

Circulating IGF-I and its protective role in the pathogenesis of diabetic angiopathy

Poor glycaemic control in type 1 diabetes is associated with elevated serum IGFBP-1 levels and reduced rather than elevated serum IGF-I levels. Increasing age is accompanied by a further decrease in serum IGF-I levels as well as an increase in IGFBP-l levels in adult diabetic type 1 and type 2 subjects. This is especially observed in diabetic type 1 subjects with manifest microvascular complications. IGFBP-I has been proposed as one of the IGF-I inhibitors in the serum of diabetics. Lowered IGF-I and increased IGFBP-1 levels in the blood may thus result in decreased IGF-I bioavailability at the tissue level. We hypothesize that the premature and progressive decline in serum IGF-I bioactivity during ageing in diabetics ultimately results in insufficient protective effects by IGF-I in the kidneys, eyes and neurones, and thus the progression of diabetic microvascular complications. If this hypothesis is proven to be right, treatment of diabetic patients with IGF-I (eventually complexed to IGFBPs) as an adjunct to insulin might prevent and not worsen the development of diabetic microvascular complications.

Tactics for type II diabetes

Type II diabetes is a prototype of chronic diseases. Given its human and economic importance, it deserves a comprehensive strategy for management; this should include a public health phase, a primary medical management phase, and a complex management phase. Public health tactics include finding susceptible persons, teaching preventive habits, and screening for early diagnosis. Primary management tactics include enhancing life-style efforts, prescribing single and combined drug regimens as directed by algorithms, and objectively testing short-term outcomes. Complex management deals with patients with diabetic complications or poor glucose control despite algorithmic tactics, who therefore need individualized treatments.