16 Sep Progressive Incremental Benefits of Targeting Lower HbA1c on Type 2 Diabetes Complications Rates

MedicalResearch.com Interview with:

Dr. Samiul Mostafa

Dr. Samiul Mostafa
Honorary Clinical Lecturer
Diabetes Trials Unit
University of Oxford

MedicalResearch.com: What is the background for this study?
Response: In managing people with Type 2 diabetes mellitus (T2DM), international guidelines recommend individualisation of HbA1c (glucose) targets for long term maintenance; however, few data are available on the potential
benefits that different blood sugar control targets might achieve.

Therefore, there is a need to learn more about the incremental benefits
of progressively lowering blood sugar levels.
In this computer modelling study, we used the UKPDS Outcomes Model
version 2.0 to estimate 10-year event rates for myocardial infarction
(MI, heart attack), stroke, blindness and amputation by entering
baseline risk factor variables (for example, weight, height,
LDL-cholesterol, systolic blood pressure) taken from a for a current
population of 5766 people with T2DM. Complication rates were estimated
with HbA1c levels held constant at 10%, 9%, 8%, 7% and 6% for each
individual whilst maintaining their risk factors at their baseline
values. Standard statistical methods were used to calculate relative
risk reductions of complications at each HbA1c level.

MedicalResearch.com: What are the main findings?

Response: The risk of complications decreased significantly for each HbA1c
decrement from 10% to 6% for all simulated outcomes. RRRs increased to a
similar extent for each 1% HbA1c decrement, but numerically were greater
for micro- than macrovascular complications. Using the example of
someone improving their HbA1c from 10% down to 7% (a common treatment
target), the authors estimated this would reduce the risk of heart
attack by 15%, stroke by 19.6%, blindness by 37%, and amputation by 52%.

MedicalResearch.com: What should readers take away from this report?
Response:

• As expected, greater estimated risk reductions were seen with HbA1c
  lowering for microvascular (amputation and blindness) than macrovascular
  (heart attack and stroke) complications.
• These simulated outcomes provide patients and clinicians a guide to the
  potential glucose-lowering benefit possible when targeting progressively
  lower HbA1c values from a baseline of 10%. This guide could be used in
  consultations to help clinicians and patient learn more about the
  potential benefits of step-wise glucose lowering.
• Running the UKPDS Outcomes Model for individual patients could give
  personalised risk reduction estimates to help better inform diabetes
  management.MedicalResearch.com: What recommendations do you have for future research as a result of this study?
  
  Response: These results provide useful information on how estimates of T2DM complication rates change with progressive lowering of glucose levels; there is a need to produce similar information for other modifiable risk
  factors in T2DM including blood pressure and LDL-cholesterol (unhealthy
  cholesterol).MedicalResearch.com: Is there anything else you would like to add?
  Response: Dr. Mostafa received an Academy of Medical Sciences starter grant for clinical lectures and Oxford University Medical Research Fund grant to undertake this research work.

  Citation:

your EASD abstract:

Identifying incremental benefits of targeting lower HbA1c levels on
Type 2 diabetes complications rates
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