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Moderate blood sugar level recommended for Type 2 diabetic patients

Gorkha Post

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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.

With Agency Inputs

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Commonly used heart, diabetes drugs may help ease mental illness

Raghu Kshitiz

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Commonly used drugs to combat physical health diseases, such as, high blood pressure, cholesterol, and diabetes could bring significant benefits to people with serious mental illnesses like schizophrenia, bipolar disorder or non-affective psychoses, according to a study led by University College London (UCL).

The researchers say their findings have “enormous potential”. But they, and independent experts, say the results now need to be tested in clinical trials.

The study published in JAMA Psychiatry assessed the health data records of over 142,000 Swedish patients with serious mental illnesses — including schizophrenia and bipolar disorder.

The starting point for the researchers was a list of currently prescribed medications that science predicts could also help patients with severe mental health disorders.

The researchers found that those patients typically fared better during periods when they were taking certain medications to treat high cholesterol, high blood pressure or diabetes.

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The study focused on those patients who had either been prescribed Hydroxylmethyl glutaryl coenzyme A reductase inhibitors (HMG-CoA RIs), more commonly known as statins—which are used to reduce cholesterol/heart disease, L-type calcium channel antagonists (LTCC), used to reduce high blood pressure, or biguanides (such as metformin), used to treat diabetes.

“Serious mental illnesses, including bipolar disorder, are associated with high levels of morbidity and are challenging to treat,” Lead author, Dr. Joseph Hayes (UCL Psychiatry), said, “Many widely used drugs, such as statins, have long been identified as having the potential for repurposing to benefit these disorders.”

“Many widely used drugs, such as statins, have long been identified as having the potential for repurposing to benefit these disorders,” Dr Hayes added.

This study is the first to use large population data sets to compare patient’s exposure to these commonly used drugs and the potential effects on people with serious mental illnesses.

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