Progressive Incremental Benefits of Targeting Lower HbA1c on Type 2 Diabetes Complications Rates Interview with:

Dr. Samiul Mostafa

Dr. Samiul Mostafa

Dr. Samiul Mostafa
Honorary Clinical Lecturer
Diabetes Trials Unit
University of Oxford 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. 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%. What should readers take away from this report?

  • 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 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) 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.


your EASD abstract:

Identifying incremental benefits of targeting lower HbA1c levels on
Type 2 diabetes complications rates
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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Last Updated on September 16, 2016 by Marie Benz MD FAAD