NEW YORK 21 may 2011--- In older diabetics, the hemoglobin A1C level should be maintained below 8.0% but generally not below 6.0%, researchers advise.
In an April 19th online paper in Diabetes Care, Dr. Elbert S. Huang of the University of Chicago and colleagues cite evidence for a U-shaped relationship between mortality and A1C levels.
Medical organizations don't agree on suitable targets in the elderly, they say.
"For clinicians and older patients living with diabetes, I believe the study emphasizes the importance of working together to select the optimal glucose control target for the individual patient. We hope that the information contained within the study can serve as a basis for that discussion," Dr. Elbert S. Huang told Reuters Health by email.
Dr. Huang and his group retrospectively studied more than 71,000 patients over 60 years old with type 2 diabetes, using data from Kaiser Permanente Northern California for the years 2004- 2008.
The average age was 71 and the mean A1C level was 7.0%. The risk of non-fatal complications rose when A1C climbed above 6.0%. Adjusted hazard ratios were 1.09 for an A1C of 6.0 to 6.9%, and 1.86 for an A1C of 11.0% or more.
As recognized before, mortality had a U-shaped relationship with A1C. Compared to levels below 6.0%, levels between 5% and 9% were linked with lower rates of death.
After adjustment for other variables, the lower mortality risk with A1C levels between 8.0% and 8.9% was no longer significant. The hazard ratio for levels of 7.0 to 7.9% was 0.83, but 1.31 at levels of 11.0% and beyond.
Risks of complications or death became significantly higher at AICs of 8.0% or more. These patterns were generally similar across age groups ranging from 60 to more than 80 years.
Dr. Huang thinks the results will help to refine suitable targeting. Also, he said, "I think that the study findings on mortality call out for more research to understand why near normal blood sugars have a link to mortality."
SOURCE: http://bit.ly/jpDvnR
Diabetes Care 2011.
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