[acb-diabetics] Interesting study

[Patricia LaFrance-Wolf]

>From Diabetes Health Newsletter.

UK Study Finds That People With A1c's of 7.5% Run Less Risk of Death Than
Those With Lower A1c's 

Patrick Totty

Feb 11, 2010 

 

Results of a 22-year study by researchers at Cardiff University School of
Medicine in Wales indicate that older 

type 2s

 who try too hard to drive their 

A1c

's down to "normal" (4.5% to 6%) may significantly increase their chances of
early death. In fact, the study, just published in the British medical
journal

The Lancet*, found that type 2s with the lowest risk of death had A1c's of
7.5% -- a figure that few authorities on the disease have recommended as
ideal.

 

The study, which tracked almost 48,000 patients age 50 and older, also found
that type 2s who used 

insulin

 to drive down 

blood sugar

 levels over the course of the study were 49 percent more likely to die than
type 2s who used oral drug combinations, such as a sulfonylurea and 

metformin.

 

The study examined data that was collected from November 1986 to November
2008 for the UK General Practice Research Database. Overall, patients with
the

highest blood sugar levels over the course of the study ran a 79 percent
greater risk of death, while patients with the lowest levels ran a 52
percent

greater risk. The "safest" group was the patients with A1c's of 7.5%.

 

The large-scale study confirms fears that were raised in the wake of the
massive ACCORD study in the United States. That study, which tracked more
than

10,000 type 2 patients, attempted to discern whether very tight control of
blood sugar levels would lessen the risk of cardiovascular disease, a common

result of diabetes's inflammatory effects. Its sponsor, the U.S. 

government

, abruptly terminated ACCORD in 2008 when a statistically significant number
of diabetes patients with heart problems who had achieved tight control died

from cardiovascular events.

 

The finding that using insulin as part of intensive treatment increased the
risk of death led the researchers to two conclusions:

 

list of 2 items

1. Type 2 patients who need insulin may be more ill than other diabetes
patients 

2. Doctors treating type 2s should try to handle their disease for as long
as possible with a combination of diet, lifestyle, and oral medications
before

shifting to insulin therapy 

list end

 

As evidence increases that driving blood sugar levels too low may subject
type 2s to as yet unexplained risks, older people with diabetes-and their
doctors-may

find themselves taking a "good enough" approach to A1c levels. The American
Diabetic Association has long recommended an A1c of 7%, a figure that has
come

under fire at times for being too high. In the wake of the Cardiff
University study, it would be ironic if people now start finding it "a bit
low."

 

*A synopsis of the study, "Survival as a function of HbA1c in people with 

type 2 diabetes

: a retrospective cohort study," is available at 

The Lancet.

 

* * *

 

Source:

 

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61969-3/ab
stract

 

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