The most intensive glucose control is associated with increased risk for death, according to a retrospective cohort study published online in the Lancet.
Using a U.K. general practice database, researchers identified two diabetic cohorts together comprising some 48,000 patients whose treatments had been intensified. One cohort started treatment with oral glucose-lowering monotherapy and switched to a combination therapy using a sulfonylurea plus metformin. The other cohort switched from oral agents alone to insulin with or without oral agents.
During the 5 years after changing therapy, the investigators noted a U-shaped curve in both cohorts with respect to all-cause mortality and levels of glycated hemoglobin — patients in the lowest decile of glycated hemoglobin (median HbA1c, 6.4%) and the highest (10.6%) had significantly higher mortality rates than those in the reference decile (7.5%).
Lancet article (Free abstract; full text requires subscription)
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Dato' Dr. Ismail Yaacob
Medical Director/Consultant Physician
Kedah Medical Centre
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