Modest Glucose Control Linked to Fewer Deaths in Diabetics

Lower mortality observed in diabetics with heart failure and modest glucose control

TUESDAY, July 21 (HealthDay News) -- Modest glucose control is associated with fewer deaths in patients with diabetes and heart failure, according to a study in the July 28 issue of the Journal of the American College of Cardiology.

David Aguilar, M.D., and colleagues from Baylor College of Medicine in Houston retrospectively examined the association between levels of glycosylated hemoglobin (HbA1C) and adverse outcomes in 5,815 veterans with heart failure and diabetes.

After two years of follow-up, the researchers found that there were fewer deaths in patients with modest glucose control, 17.7 percent of patients with HbA1C greater than 7.1 percent and less than or equal to 7.8 percent, compared with 25 percent of patients with HbA1C of 6.4 percent or less (risk-adjusted hazard ratio, 0.73), and 23.2 percent of patients with HbA1C over 9 percent. The risk of hospitalization for heart failure also increased with increasing quintiles of HbA1C, but was not statistically significant after adjusting for potential confounding factors.

"Glycemic control as measured by glycohemoglobin or nonspecific advanced glycated end products may not adequately reflect the elements of diabetes that lead to an excess in mortality or decreased microvascular blood flow," Larry A. Weinrauch, M.D., and Eldrin F. Lewis, M.D., from Harvard Medical School in Boston write in an accompanying editorial. "In the 70-year-old heart failure patient with diabetes, this study suggests that there is little benefit to a glycohemoglobin level below 7.1 percent."

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