Intensive Glycemic Control May Spike Diabetes Mortality
Study also finds increased mortality with slack control and advises mid-range HbA1c target
THURSDAY, Jan. 28 (HealthDay News) -- Intensive treatment for type 2 diabetes mellitus that drives the patient's glycated hemoglobin (HbA1c) level too low, or insufficient treatment that leaves it too high, both increase mortality risk, according to a study published online Jan. 27 in The Lancet.
Craig J. Currie, Ph.D., of the University of Cardiff in the United Kingdom, and colleagues analyzed two cohorts of patients with type 2 diabetes from the U.K. General Practice Research Database, including 27,965 patients whose treatment had been stepped up from oral monotherapy to combination therapy with oral blood-glucose lowering agents (sulphonylurea plus metformin), and 20,005 patients whose treatment had been stepped up from oral agents to include insulin. The study outcome was all-cause mortality, which the researchers correlated to HbA1c levels by decile. Results were adjusted for age, sex, cholesterol, cardiovascular risk, smoking, and overall morbidity.
Compared to the HbA1c decile with the lowest mortality risk (decile 7.5 percent), the researchers found that the mortality risk was elevated for patients in the lowest HbA1c decile (decile 6.4 percent; hazard ratio, 1.52) and in the highest HbA1c decile (decile 10.5 percent; hazard ratio, 1.79). Subjects treated with insulin-based regimens were at higher mortality risk than those treated with combination oral agents (hazard ratio, 1.49).
"Low and high mean HbA1c values were associated with increased all-cause mortality and cardiac events. If confirmed, diabetes guidelines might need revision to include a minimum HbA1c value," the authors write.
Several of the study authors are employees of Eli Lilly and Company, which funded the study. Also, several study authors reported that they have worked as consultants for a number of pharmaceutical companies.