Lack of thresholds
We observed no thresholds of glycaemia for any type of complication of diabetes. This suggests that there is no specific target value of haemoglobin A1c for which one should aim but that the nearer to normal the haemoglobin A1c concentration the better. In reality, it is difficult to obtain and maintain near normal concentrations of haemoglobin A1c in patients with type 2 diabetes, particularly in those with a high concentration of haemoglobin A1c at diagnosis of diabetes.Intensification of treatment by adding insulin to improve the relatively modest reduction in glycaemia achieved with oral hypoglycaemic treatments can be constrained by reluctance from patients and providers because, in part, of side effects such as hypoglycaemia or weight gain. These observational analyses, together with the results of the clinical trial, however, indicate that any improvement in a raised hemoglobin A1c concentration is likely to reduce the risk of diabetic complications.