Study shows that high-risk patients should aim for A1C levels between six and eight percent.
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(HealthNewsDigest.com) – LOS ANGELES, Calif. — January 3, 2011 — High risk adults with type 2 diabetes whose long-term blood sugar levels, as measured by A1C, were very high or very low may be at greater risk of heart attack and stroke compared to those whose levels stayed at American Diabetes Association targeted level of seven percent, according to a new study in Diabetes Care.
The nested case control study compared 11,157 men and women with type 2 diabetes who suffered heart attack, stroke or death from heart disease to a matched control group of 44,628 persons with diabetes and found that patients with mean A1C levels of less than six percent or greater than eight percent over a three-year period were at increased risk of heart attack, stroke or death from heart disease..
“Our study shows that aggressive glycemic control may not always be the best treatment strategy for persons with type 2 diabetes,” said study lead author Danielle Colayco, a USC School of Pharmacy graduate, now a principal research associate in Global Health Outcomes Strategy and Research at Allergan.
While people without diabetes usually have A1C levels –a measurement of blood sugar over the past three months– of less than 5 percent, the American Diabetes Association recommends that people with diabetes should be treated to reach and maintain a level of 7 percent. Colayco’s interest was piqued by a 2008 randomized control study, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which showed that people with diabetes who had been aggressively treated to reduce their A1C levels to less than 6 percent were more likely to die than those whose levels were reduced and maintained in the 7 to 8 percent range.
The research, conducted by Colayco; Pharmacy Analytical Services biostatistician Fang Niu, MS; research scientist T. Craig Cheetham, PharmD, MS; and USC School of Pharmacy professor Jeffrey McCombs, PhD, analyzed clinical and laboratory information from Kaiser Permanente members throughout Southern California. Their study’s findings are consistent with the ACCORD trial’s findings. McCombs is a health economist while Niu and Cheetham are with Kaiser Permanente’s Pharmacy Analytical Service and the Department of Research and Evaluation (R&E) in Pasadena, California.
“Conducting research in partnership with Kaiser Permanente colleagues allowed for findings that are generalizable to a wider population of patients than those often included in randomized controlled trials,” Colayco says.
Their research found that within the studied population of adults with type 2 diabetes, those who had A1C levels that were very high or very low had a greater risk of suffering from stroke, heart attack and other cardiovascular events as opposed to those whose levels were greater than six percent and less than eight percent.
“Our research supports the findings of the ACCORD study, providing additional evidence that aggressive A1C targets may not be optimal for all patients with diabetes,” Cheetham says.
For a person living with type 2 diabetes, Colayco says the take-away message is to remain involved in your own care and be aware of potential benefits and risks related to treatment. “Patients need to have an ongoing dialogue with their healthcare professional and treatment plans need to be customized for each patient,” Colayco says.
Professor McCombs put the study into the context of new federal emphasis on comparative effectiveness research that is thought to be a key for reducing costs while improving quality of care. “This study is an example of how research, using information contained in the electronic medical records [EMR] system, can be used to determine ‘what works best’ for patients. Kaiser Permanente and other integrated health care systems are at the forefront of implementing EMR systems and conducting research using these data to improve patient outcomes and reduce cost.”
The study was a collaborative effort between the USC School of Pharmacy and Kaiser Permanente’s Pharmacy Analytical Service and the Department of Research & Evaluation.
About the USC School of Pharmacy
The USC School of Pharmacy is the top ranked private pharmacy school in the nation. Since its establishment over a century ago, the School has played a pivotal role in the pharmacy profession — including offering the nation’s first Doctor of Pharmacy degree in 1950. Continuing to evolve to meet the needs of a changing world, the School offers numerous joint and dual degree programs to pharmacy students, a vibrant pharmaceutical economics and policy program and the nation’s only doctoral program in regulatory science. The School is located on a major health sciences campus which affords students unique and diverse clinical experiences and opportunities for interdisciplinary collaboration.
About the Kaiser Permanente Department of Research and Evaluation
The Department of Research and Evaluation (R & E) conducts high quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiology, health sciences, and behavioral research as well as clinical trials. Areas of interest include diabetes and obesity, cancer, HIV/AIDS, cardiovascular disease, aging and cognition, pregnancy outcomes, women’s and children’s health, quality and safety, and pharmacoepidemiology. Located in Pasadena, Calif., the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general population. Visit www.kp.org/research.
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