Good glycaemic levels: the secret to preventing damage and complications

Answer: Maintaining good glycaemic levels is crucial in the management of diabetes, both type 1 and type 2, because glycaemic control is the key to preventing or delaying the onset of disease-related complications. In type 1 diabetes, where the pancreas does not produce insulin because beta cells are destroyed by an autoimmune process, glycaemic control is particularly delicate. Insulin must be administered externally via injections or continuous subcutaneous infusion systems, and the amount of insulin needed may vary depending on physical activity, diet and stress. Careful management avoids persistent hyperglycaemia, but also hypoglycaemia, situations in which blood glucose drops too low, with immediate risks such as fainting or seizures. For this reason, continuous or frequent blood glucose monitoring is essential in type 1 diabetes, as is adaptation of insulin therapy.

In type 2 diabetes, on the other hand, the initial problem is resistance to insulin by cells in various organs, which are unable to use it effectively. Initially, the pancreas can compensate by increasing insulin production, but over time this capacity diminishes. Here, maintaining adequate glycaemic levels relies on a multifactorial approach: diet, physical activity, oral or injectable medication and, in some cases, insulin. Glycaemic control is crucial to prevent long-term complications. Complications of diabetes, both type 1 and type 2, mainly affect the blood vessels and nerves. When blood sugar remains elevated for a long time, the risk of microvascular damage increases: diabetic retinopathy (which can lead to blindness), nephropathy (kidney failure and dialysis) and neuropathy (peripheral nerve damage). In addition, diabetes also accelerates the processes of atherosclerosis, i.e. the accumulation of plaque in the arteries, increasing the risk of heart attacks, strokes and other cardiovascular diseases. Special attention must be paid to the diabetic foot, which is characterised by lesions and ulcers that, if not treated properly, can lead to serious infections and, in the most serious cases, amputations.

A landmark study, the Ukpds (United Kingdom Prospective Diabetes Study), has shown that even a moderate improvement in glycaemic control significantly reduces the risk of long-term complications. This has led national and international guidelines to recommend keeping the HbA1c, i.e. the average blood glucose indicator of the last 2-3 months, within certain limits (usually around 7%, preferably less than 6.5% and personalised according to age and health conditions).

In type 1 diabetes, however, the goal of glycaemic control has to be balanced with the risk of hypoglycaemia, especially in young individuals or those with poorly perceived symptoms of falling blood sugar. Technology, through the use of continuous glycaemic sensors and insulin pumps, is greatly improving this aspect, allowing for more stable and safer control.

In type 2 diabetes, diagnosis often comes late, when complications or subclinical damage are already present. This is why maintaining good glycaemic levels becomes essential to prevent the worsening of the disease and the appearance of new problems. In these patients, glycaemic control is integrated with the management of other cardiovascular risk factors such as weight, high blood pressure, cholesterol and smoking.

In addition to the risk of complications, maintaining adequate glycaemic levels also helps improve quality of life. Symptoms of inadequate glycaemic control, such as fatigue, reduce the ability to concentrate, work or exercise. Good glycaemic control therefore allows greater energy, well-being and productivity.

Lastly, it is important to emphasise that glycaemic control is not a static goal: in particular, when using drugs that can cause hypoglycaemia, such as insulins or glucose-independent secretagogues, it must be customised according to the patient's characteristics, age, the presence of other diseases and the patient's ability to manage the therapy.