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Moderate blood sugar level recommended for Type 2 diabetic patients

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WASHINGTON — Moderate blood sugar levels are recommended for patients with Type 2 diabetes, according to a new research from the Endocrine Society and Avalere Health which was conducted by the American College of Physicians.

The findings published in the journal Annals of Internal Medicine, stated that patients with Type 2 diabetes should be treated to achieve an A1C between 7 percent and 8 percent rather than 6.5 percent to 7 percent.

An A1C test measures a person’s average blood sugar level over the past two or three months. An A1C of 6.5 percent indicates diabetes.

“ACP’s analysis of the evidence behind existing guidelines found that treatment with drugs to targets of 7 percent or less compared to targets of about 8 percent did not reduce deaths or macrovascular complications such as heart attack or stroke but did result in substantial harms,” said researcher Jack Ende.

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“The evidence shows that for most people with type 2 diabetes, achieving an A1C between 7 percent and 8 percent will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs.”

ACP recommended that clinicians should personalise goals for blood sugar control in patients with type 2 diabetes based on a discussion of benefits and harms of drug therapy, patients’ preferences, patients’ general health and life expectancy, treatment burden, and costs of care.

The rationale in guidelines that recommended lower treatment targets (below 7 percent or below 6.5 percent) is that more intensive blood sugar control would reduce microvascular complications over many years of treatment.

However, the evidence for reduction is inconsistent and reductions were seen only in surrogate microvascular complications such as the presence of excess proteins in the urine.

Researchers in Sweden and Finland last week, published a new report suggesting that Type 2 diabetes should actually be broken down into five separate types, in the hopes of better tailoring treatments to individuals suffering the disease.

The pancreases of diabetics do not properly process sugar, either because their bodies do not produce enough insulin in Type 1 or because they have too high of an insulin tolerance in the set of variations formerly called Type 2.

If patients with Type 2 diabetes achieve an A1C of less than 6.5 percent, ACP recommended that clinicians consider de-intensifying drug therapy by reducing the dosage of current treatment, removing a medication if the patient is currently taking more than one drug, or discontinuing drug treatment.

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“Results from studies included in all the guidelines demonstrate that health outcomes are not improved by treating to A1C levels below 6.5 percent,” Dr. Ende said.

“However, reducing drug interventions for patients with A1C levels persistently below 6.5 percent will reduce unnecessary medication harms, burdens, and costs without negatively impacting the risk of death, heart attacks, strokes, kidney failure, amputations, visual impairment, or painful neuropathy.”

ACP also recommended that clinicians should treat patients with Type 2 diabetes to minimize symptoms related to high blood sugar rather than targeting an A1C level in patients with a life expectancy less than 10 years due to advanced age — 80 years or older — or chronic conditions (such as dementia, cancer, end stage kidney disease, severe COPD or congestive heart failure, and patients residing in nursing homes), as the harms of A1C targeted treatment outweigh the benefits in this patient population.

“Although ACP’s guidance statement focuses on drug therapy to control blood sugar, a lower treatment target is appropriate if it can be achieved with diet and lifestyle modifications such as exercise, dietary changes, and weight loss,” said Dr. Ende.

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Single blood test might be enough to diagnose diabetes

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A new study report has suggested that it may be possible to diagnose type 2 diabetes by measuring fasting blood glucose and hemoglobin A1c (HbA1c) using the same blood sample without requiring a patient to come back for a second visit and saving patients time and health care cost.

The findings, from the prospective Atherosclerosis Risk in Communities (ARIC) study, were published online June 19 in Annals of Internal Medicine by Elizabeth Selvin, PhD, of Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and colleagues.

Until now, it’s recommended that a blood test focused on elevated fasting levels of blood sugar (glucose) or a blood component called glycated hemoglobin (HbA1c) be confirmed with a second blood test at a follow-up visit which takes time and money and could still result in missed diagnoses, said a team from the Johns Hopkins Bloomberg School of Public Health in Baltimore.

In the new study, researchers led by Hopkins epidemiologist Elizabeth Selvin looked at data on more than 13,000 people in a long-running US heart disease study. The study began in the 1980s, and along the way has recorded valuable data from participants, including diabetes test data.

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The team analyzed that data, and reported that a positive result for glucose and HbA1c from just a single blood sample can confirm type 2 diabetes.

” This could change care potentially allowing a major simplification of current clinical practice guidelines,” Selvin said in a university news release.

“Doctors are already doing these [glucose and HbA1c] tests together — if a patient is obese, for example, and has other risk factors for diabetes, the physician is likely to order tests for both glucose and HbA1c from a single blood sample.

“It’s just that the guidelines don’t clearly let you use the tests from that one blood sample to make the initial diabetes diagnosis,” she explained.

“I’m hoping that these results will lead to a change in the clinical guidelines when they are revised in early 2019, which could make identifying diabetes a lot more efficient in many cases,” Selvin said.

Diabetes experts welcomed the findings.

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