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Intensive blood sugar lowering has worse long-term mortality

By Christian Duffin

The intensive use of therapy to chase aggressive blood sugar targets in patients with type 2 diabetes results in increased five-year mortality, a new analysis of the ACCORD study shows.

Researchers randomly assigned 4,733 participants with type two diabetes and cardiovascular disease or additional cardiovascular risk factors to receive intensive therapy, targeting a HbA1c level of 6.0% or lower, or standard therapy, which targeted an HbA1c level of between 7.0 and 7.9%.

Compared to standard therapy, the use of intensive therapy for a mean of 3.7 years reduced five-year non-fatal myocardial infarctions by 21%, but increased five-year mortality by 19% compared to the standard therapy group,

The researchers terminated the intensive therapy arm of the study early due to the higher mortality rates, after recording 283 deaths from any cause in the intensive therapy group, compared to 232 in the standard group.

Research team leader Dr Hertzel Gerstein, director of the endocrinology and metabolism division at McMaster University in Ontario, said: ‘Several organizations have recommended glycaemic targets of 6.5% or lower….such a strategy cannot be recommended for high-risk patients with advanced type 2 diabetes.

‘These findings are most applicable to middle-aged and older patients with a long duration of diabetes, a high risk of cardiovascular disease, and hyperglycaemia.’

N Engl J Med 2011;364:818-28

Intensive blood sugar lowering can be harmful in high risk patients