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.
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Sudden cardiac arrests are more likely to happen on any day at any time : Study
A new study has showed that sudden cardiac arrests are more likely to happen on any day at any time, challenging previous claims that weekday mornings — especially Mondays — were the danger zones.
Previously heart experts have long believed that weekday mornings were the danger zones for unexpected deaths from sudden cardiac arrests.
“While there are likely several reasons to explain why more cardiac arrests happen outside of previously identified peak times, stress is likely a major factor,” said Sumeet Chugh, a Professor of medicine from the Smidt Heart Institute in the US.
“We now live in a fast-paced, ‘always on’ era that causes increased psycho-social stress and possibly an increase in the likelihood of sudden cardiac arrest,” Chugh added.
Almost 17 million cardiac deaths occur annually worldwide while the survival rate from sudden cardiac arrest is less than one per cent.
For the study, published in the journal Heart Rhythm, Chugh’s team analysed data on 1,535 from the community-based Oregon Sudden Unexpected Death Study between 2004 to 2014, among which only 13.9 per cent died in the early morning hours, the findings revealed.
All reported cases were based on emergency medical service reports containing detailed information regarding the cause of the cardiac arrest.
“Because sudden cardiac arrest is usually fatal, we have to prevent it before it strikes,” Chugh said. “Our next steps are to conclusively determine the underlying reasons behind this shift, then identify public health implications as a result,” he added.
Apart from stress, other contributing factors may be a shift in how high-risk patients are being treated, as well as inadequacies in how past studies have measured time of death caused by sudden cardiac arrest.Follow @gorkhapost