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Strict diabetes targets 'have no effect on mortality'

By Lilian Anekwe

Stringent targets for blood glucose in diabetes set by NICE and in the QOF may not bring any benefits for reducing overall mortality, new research suggests.

The meta-analysis of five trials found while more intensive blood glucose control in type 2 diabetes led to a ‘consistent' reduction in heart attacks and coronary events, it had no significant effect on stroke or all-cause mortality.

The study, published in The Lancet last week, will add further weight to the growing controversy over the stringent new QOF targets for diabetes - and whether the benefits of aggressive treatment outweigh the potential risks.

HbA1c was on average 0.9% lower, at 6.6%, in patients given more intense treatment than those given standard treatment, at 7.5%.

Patients in the high-intensity treatment group had a 17% reduced risk of non-fatal heart attacks and a 15% reduction in coronary events, but their risk of stroke or all-cause mortality was not significantly different from those on standard treatment.

Study leader Dr Kausik Ray, senior clinical research associate at the University of Cambridge, concluded rather than focus on lowering blood glucose, GPs should focus their efforts on lowering cholesterol and blood pressure.

‘Our findings provide reassurance about the effectiveness of glycaemic control for cardiovascular risk reduction, but we have not proven a clear benefit to all-cause mortality.

‘By contrast, strong evidence suggests lipid-lowering and blood pressure reduction does benefit all-cause mortality, which reinforces the crucial importance of these treatments.'

Dr Pam Brown, a GP in Swansea and a member of the Primary Care Diabetes Society steering committee, said: ‘Macrovascular disease risk is multifactorial and it's not just about tight glucose control. The earlier we can lower blood glucose, as well as lipids and blood pressure, the better.'

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