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lowest hba1c group has highest mortality?

M

mikeyuk

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Was reading a study today that said that the group who had the lowest hba1c (10% were below 6.7%) had the highest mortality second only to those who had an hba1c exceeding 9.9, and that from this data an hba1c around over 7% seems the best.

For someone like me striving to get my hba1c under 6 im quite disappointed by this, was just wondering if anyone else had read this and what they made of it?

An exerpt can be found here : http://www.library.nhs.uk/Diabetes/View ... sID=345735

under the heading hba1c and mortality.
 
Hi Mike :)

As in all these studies you sometimes can be more re-assured by what is between the lines and I amuse myself by prodding and poking for such things. :roll:

I notice that they don't mention the age of those who have died or how long they have kept their levels down low and nor do they mention how long they have been diagnosed. The ages of those who haven't died are not mentioned and neither is the condition of anyone at all. :roll:

At the end of the day, if we are sensible, we do our best to keep our levels down to avoid the devastating consequences of uncontrolled BG levels so I reckon if you live a long time without the complications and die at a ripe old age you would still figure on these statistics wouldn't you?! I would be happy with that!! :D 8)
 
Hi mickey,
The study you are referring to was about Type 2's and I see from your profile that you are Type 1. As long as your team are happy with the results that you are getting and you are not having frequent hypos please do not read anything into this.

Here is another study of a similar type and according to experts, "It does not provide answers as to what caused the excess mortality. We still do not know why patients in the intensive group died. We wish we knew what it was about this group that caused the additional risk, but we don't"

His team is continuing to investigate potential causes of the mortality, including the role of weight gain during the study.

http://www.medicalnewstoday.com/articles/186928.php
 
I agree Synonym and Catherine, I'm not convinced by the data source of the study either. ; GPs notes,

I noted this
The commentary says that this study although it supports the results of RCT’s such as ACCORD cannot show as causal relationship between HBA1c and mortality. However the results are consistent with the idea that premature death may be related to hypoglycaemia.
Click to expand...
Unfortunately for the authors, too late for their paper, the Accord researchers have now analysed and revised their findings.
They found no evidence that hypos were a problem.
http://www.medicalnewstoday.com/articles/153578.php

Morevover, (as mentioned in the article linked by Catherine) they have very recently published a paper with very different findings. There were more deaths in the intensive arm, but this was in people who were unable to lower their HbA1cs in spite of the intensive medication.

Various characteristics of the participants and the study sites at baseline had significant associations with the risk of mortality. Before and after adjustment for these covariates, a higher average on-treatment A1C was a stronger predictor of mortality than the A1C for the last interval of follow-up or the decrease of A1C in the first year. Higher average A1C was associated with greater risk of death. The risk of death with the intensive strategy increased approximately linearly from 6–9% A1C and appeared to be greater with the intensive than with the standard strategy only when average A1C was >7%.

CONCLUSIONS These analyses implicate factors associated with persisting higher A1C levels, rather than low A1C per se, as likely contributors to the increased mortality risk associated with the intensive glycemic treatment strategy in ACCORD
Click to expand...
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Diabetes Care May 2010
 
I am wondereing if the people with type 2 D were following the high carb diet and the intensive treatment was with tablets/insulin rather than lowering bg levels with a lower carb diet with or with out tablets/insulin.
 
The studies done on Tight control by medication, all show that it leads to increased mortality. I don't know how many studies have been done on tight control by diet.
I'm not surprised that mega doses of several different medicines is dangerous. However, I have an HbA1c of 5.1% and it's never been over 6.5%. I use minimal medicaion and depend mainly on diet and exercise.
I'm not being scared off my chosen pathway. I am fit and well. Hardly even get a cold and can walk 5 miles without struggling.

Hana
 
I have read a review of this work, but I can't find it right now, which was highly scathing of the type of subjects chosen and the type of medication they have previously been prescribed.

As we all know A1C is an average and can be full of very high and very low readings to give a low A1C reading. What is needed is stable blood glucose levels with a stable A!C, this piece of research has it's own problems.

I will post the link to the review when I find it.

Found it:

http://diabetesupdate.blogspot.com/2010 ... ed-by.html

This sheds some light on the study.
 
oooh er!! I'm a wee bit scared now by that report. I'm 52, T2, was on insulin for 5 years before Byetta, BM's weren't too bad, but have significantly improved since stopping starchy carbs. Should I book an undertaker yet???? :( :(
 
Folks
look up comments on the ACCORD and ADVANCE studies. In fact look up David Mendosa on those studies.
Hana
 
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