Monday, January 28, 2013

Achieving an A1c of 7.5 may be a better target for many of us

Question - 
Is hypoglycemia associated with increased mortality ?         Yes    or   no

Recent studies

Two recent studies , * Accord and Advance studies , reported a higher mortality rate in both the intensive treatment (A1c goal < 6 ) and standard treatment ( A1c goal 7  to 7.9 ) groups in patients with hypoglycemia.

 The mortality rate , in the Accord Study , was highest in the group of patient with A1c > 8.5 struggling to achieve and A1c of 6 .

Bonds et al                            BMJ 2010; 340 :b4909
Zoungas et al                        N . England J. med 2010;363:14108
Calles- Escandon et al         Diabetes Care 2010 Apr; 33(4): 721-7 

Take home message
   Achieving an A1c of 7.5 may be a better target for many of us

Many  people with  diabetes can achieve A1c of 6  or less without  hypoglycemia
This group benefits with reduced risk of eye , nerve and kidney damage . The  cardiovascular benefits of achieving an A1c < 6 is still not definite.

The person with longer duration of diabetes , higher unstable glucose levels
( A1c 8.5 + )   with hypoglycemia and a history of heart disease may put themselves at increased risk struggling to achieve an A1c of 6. 

Setting and trying to achieve blood glucose and A1c goals  is a very individual process and determined by the problems mentioned in the above paragraphs.
A recent study *  provides more support for the idea glucose and A1c individuality. 
 Data discussed in this study demonstrates the lowest mortality in people achieving A1c 's in the 7. to 7.5 range with mortality rates going up as the A1c dips below 7  toward 6 and increase as the A1c progresses above 7.5 to 8.

Currie et al. Lancet , 2010; 375 (9713): 481-9

Have Fun Be Smart chose your targets carefully
David Calder,MD

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Your comments and questions are appreciated. David Calder,MD