Forums » Open clinical » Diabetes » HbA1c levels and all-cause mortality in type 2 diabetic patients: Epidemiological evidence of the need for personalised therapeutic targets.
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HbA1c levels and all-cause mortality in type 2 diabetic patients: Epidemiological evidence of the need for personalised therapeutic targets.
posted at 24/6/2012 5:43 PM BST
on bmj.com
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Posts: 461
First: 29/4/2011 Last: 31/5/2013 |
Nutr Metab Cardiovasc Dis. 2012 May 25. [Epub ahead of print] HbA1c levels and all-cause mortality in type 2 diabetic patients: Epidemiological evidence of the need for personalised therapeutic targets.AbstractBACKGROUND AND AIM:The aim of the present case-control study is to explore the effect of case mix on the relationship between glycated haemoglobin (HbA1c) and mortality in type 2 diabetic patients. METHODS AND RESULTS:A nested case-control study data set was generated from the cohort-study data set (n = 4140 type 2 diabetic outpatients) by sampling controls from the risk sets. Cases (n = 427) were compared with an equal number of controls chosen from those members of the cohort who were at risk for the same follow-up time of the case, matched for age (±3 years), sex, body mass index (BMI) (±2 kg m(-2)), duration of diabetes (±5 years), and Charlson's Comorbidity Score (CCS) (±1). The main predefined analysis was the comparison of cases and controls for proportion of patients with each HbA1c class (<6.5%, 6.5-7.4%, 7.5-8.4% and ≥8.5%). During a mean follow-up of 5.7 ± 3.5 years, 427 deaths were recorded. The lowest risk of death was observed in the HbA1c 6.5-7.4% category; a lower HbA1c was associated with a non-significant trend towards a higher risk. The risk associated with a low (<6.5%) HbA1c was significantly greater in patients who were insulin-treated than in the rest of the sample. CONCLUSIONS:The present study suggests that glycaemic targets should be individualised on the basis of the characteristics of each patient, considering age, co-morbidity and duration of diabetes. Caution should be used in prescribing insulin to reach near-normoglycaemia, particularly in older, frail patients. Nutr Metab Cardiovasc Dis. 2012 May 25. [Epub ahead of print] COMMENT: A well-designed case control study that supports the notion of individualizing A1C targets especially in alder, frail patients. |
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Re: HbA1c levels and all-cause mortality in type 2 diabetic patients: Epidemiological evidence of the need for personalised therapeutic targets.
posted at 24/6/2012 10:07 PM BST
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
An important clinical study again! which reveals that glycaemic targets should be individualised on the basis of the characteristics of each patient, considering age, co-morbidity and duration of diabetes. Caution should be used in prescribing insulin to reach near-normoglycaemia, particularly in older, frail patients. Many thanks. |
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Re: HbA1c levels and all-cause mortality in type 2 diabetic patients: Epidemiological evidence of the need for personalised therapeutic targets.
posted at 25/6/2012 1:52 PM BST
on bmj.com
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Posts: 312
First: 2/6/2012 Last: 10/5/2013 |
diabetes and its comorbidity with age,duration of DM and control of DM in respect to hba1c<7,bp<130/70,ldl<100 influence mortality. old patient with ckd adversely respond with insulin. |
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Re: HbA1c levels and all-cause mortality in type 2 diabetic patients: Epidemiological evidence of the need for personalised therapeutic targets.
posted at 25/6/2012 3:47 PM BST
on bmj.com
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Posts: 233
First: 15/5/2012 Last: 11/6/2013 |
In Response to HbA1c levels and all-cause mortality in type 2 diabetic patients: Epidemiological evidence of the need for personalised therapeutic targets.: Nutr Metab Cardiovasc Dis. 2012 May 25. [Epub ahead of print] HbA1c levels and all-cause mortality in type 2 diabetic patients: Epidemiological evidence of the need for personalised therapeutic targets. Abstract BACKGROUND AND AIM: The aim of the present case-control study is to explore the effect of case mix on the relationship between glycated haemoglobin (HbA1c) and mortality in type 2 diabetic patients. METHODS AND RESULTS: A nested case-control study data set was generated from the cohort-study data set (n = 4140 type 2 diabetic outpatients) by sampling controls from the risk sets. Cases (n = 427) were compared with an equal number of controls chosen from those members of the cohort who were at risk for the same follow-up time of the case, matched for age (±3 years), sex, body mass index (BMI) (±2 kg m(-2)), duration of diabetes (±5 years), and Charlson's Comorbidity Score (CCS) (±1). The main predefined analysis was the comparison of cases and controls for proportion of patients with each HbA1c class (<6.5%, 6.5-7.4%, 7.5-8.4% and ≥8.5%). During a mean follow-up of 5.7 ± 3.5 years, 427 deaths were recorded. The lowest risk of death was observed in the HbA1c 6.5-7.4% category; a lower HbA1c was associated with a non-significant trend towards a higher risk. The risk associated with a low (<6.5%) HbA1c was significantly greater in patients who were insulin-treated than in the rest of the sample. CONCLUSIONS: The present study suggests that glycaemic targets should be individualised on the basis of the characteristics of each patient, considering age, co-morbidity and duration of diabetes. Caution should be used in prescribing insulin to reach near-normoglycaemia, particularly in older, frail patients. Nutr Metab Cardiovasc Dis. 2012 May 25. [Epub ahead of print] COMMENT: A well-designed case control study that supports the notion of individualizing A1C targets especially in alder, frail patients. Posted by diabetesMD An excellent study and post. Could you be kind to comment on the fledgling current discussion of using insulin prophylactically. |
Forums » Open clinical » Diabetes » HbA1c levels and all-cause mortality in type 2 diabetic patients: Epidemiological evidence of the need for personalised therapeutic targets.
