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.
“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.
“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.
With Agency InputsFollow @gorkhapost
Urinary, respiratory tract infections may double stroke risk
NEW YORK — People who are suffering from urinary or respiratory tract infections may face nearly double the risk of heart attacks and strokes than obesity, researchers have warned.
The study — led by a researcher of Indian origin — found that if the frequency of these common infections causing hospitalisation continues for a longer period it may even lead to death.
Patients diagnosed with any one of these common infections were three times more likely to die than those without prior infection after developing heart disease, and almost twice as likely to die if they had a stroke.
“Our figures suggest that those who are admitted to hospital with a respiratory or urinary tract infection are 40 per cent more likely to suffer a subsequent heart attack, and 2.5 times more likely to have a stroke, than patients who have had no such infection, and are considerably less likely to survive from these conditions,” Rahul Potluri, researcher at Britain’s Aston University, said in a statement.
The effects of the common infections were of similar magnitude among the people suffering from diabetes, hypertension, and cholesterol, researchers said.
“It is notable that infection appears to confer as much, if not more, of a risk for future heart disease and stroke as very well established risk factors such as high blood pressure and diabetes,” Potluri added.
Researchers conducted the study over 34,027 patients who had been admitted with a urinary or respiratory tract infection with an age and sex-matched control group without infection.
Factors such as age, gender, ethnicity, obesity and tobacco use, as well as medical conditions including excess cholesterol, high blood pressure, diabetes and kidney disease, heart failure and atrial fibrillation were also taken into account.Follow @gorkhapost
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