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No mortality benefit in reducing HbA1c below 9%

By Lilian Anekwe

There is little to gain in terms of reduced mortality from continually lowering HbA1c targets in patients with type 2 diabetes, a Dutch study has concluded.

Dutch researchers recorded the survival status of 1,145 patients with type 2 diabetes for a median of 5.8 years.

Patients with an average HbA1c of 9% or more had a 2.2-fold higher total mortality risk and a 3.1-fold higher risk of cardiovascular mortality compared with a group treated to a target HbA1c level of between 6.5 and 7%.

But patients with an average HbA1c of less than 9% did not have significantly different risks for total or cardiovascular mortality. An HbA1c level of less than 6.5% did not change cardiovascular and all-cause mortality risk when compared with the normal target range of 6.5-7%.

Study leader Dr Gijs Landman, a researcher in internal medicine at the Isala Diabetes Centre in the Netherlands, said ‘HbA1c level was associated with mortality and this effect seemed largely attributable to patients who were in really poor glycaemic control.

‘The absence of differences in mortality in the groups with lower HbA1c levels supports the position that there is no basis for continually decreasing the therapeutic target HbA1c level in patients with type 2 diabetes.'

British Journal of General Practice, 2010;60:172-175.

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