Friday, January 13, 2012

Hypoglycemia risk may sometimes out weigh the advantage of having a " normal A1c result "

 We have very good data supporting the reduced risk of eye , nerve and kidney damage by achieving an A1c of  7.  We have some data supporting the idea of reduced reduced cardiovascular risk with achieving the same target. I have attached part of  a discussion that outlines more of the risk associated with our efforts to reach normal glucose levels in everyone with diabetes. The risk of hypoglycemia may sometimes out weigh the advantage of having normal blood glucose test.  I have highlighted the area that you may want to read.  This is something you and your doctor need to discuss.                                                                                            David Calder,MD

and don't forget to visit Laughing at LIfe by Mark to gain a little insight into the lows from a personal point of view...


Using ACCORD to Target HbA1c: Think Ages and Stages

An Expert Interview With Faramarz Ismail-Beigi, MD

Linda Brookes, MSc
Posted: 01/04/2011
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An Interview With Faramarz Ismail-Beigi, MD

About the Interviewee

Faramarz Ismail-Beigi, MD, PhD, is a Professor of Medicine, Endocrinology, and Physiology and Biophysics at Case Western Reserve University, University Hospitals of Cleveland, and the Cleveland VA from 1993-2008. He served as Chief of Endocrinology at Case from 1993-2007. His interests are in teaching, clinical diabetes research, and basic research in thyroid hormone action, glucose transport biology, and insulin action. He was the Principle Investigator of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial for the Ohio/Michigan Network. Dr. Ismail-Beigi was also the Diabetologist PI of another multicenter National Institutes of Health (NIH)-funded diabetes trial that was conducted at University Hospitals of Cleveland, the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, which was in some ways complementary to the ACCORD trial. He has authored more than 150 basic and clinical science papers.

Background to the Interview

The ACCORD trial, sponsored by the National Heart, Lung and Blood Institute (NHLBI), was set up to test the efficacy of 3 medical treatment strategies (blood glucose lowering, blood pressure lowering, and lipid altering) in reducing cardiovascular events in middle-aged and older people with type 2 diabetes plus established cardiovascular disease (CVD) or additional (≥ 2) cardiovascular risk factors.[1,2] The multicenter, double 2×2 factorial design ACCORD trial recruited 10,251 patients in the United States and Canada, all of whom participated in the glycemia arm of the trial. This arm compared a strategy of intensive glycemia therapy targeting normal glycosylated hemoglobin (HbA1c) levels (< 6.0%) with a treatment strategy targeting HbA1c 7.0%-7.9%. The primary outcome measure for this as well as the other 2 arms of the trial was a composite of nonfatal myocardial infarction (MI), nonfatal stroke, or cardiovascular death. A total of 5128 patients were randomized to intensive glycemia treatment group and 5123 to standard treatment. Intensive therapy was stopped in February 2008 after a median of 3.5 years, because of a statistically significant 22% relative and 27% per year absolute increase in all-cause mortality seen in that group.[3] The patients in the intensive glycemia arm were transitioned to standard therapy for the remainder of the median 5.0 years of follow-up. At the point of transition there was no significant reduction in major cardiovascular events (primary study outcome) with intensive glycemic therapy compared with standard therapy.

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Your comments and questions are appreciated. David Calder,MD