A new study of elderly diabetic patients found that well controlled blood glucose was associated with the reduction of the risk of major heart attacks, amputation and complications of kidney disease, but much lower blood sugar levels were associated with an increase in small but significant risk of death.
The study, published in the June 2011 of the Diabetes Care journal number, which followed more of 70 000 patients with diabetes type 2 of Kaiser Permanente, which have more than 60 years of the age of four.
Based on these results come from a study of observation and not a randomized clinical trial, you need to understand their clinical implications more research.
"We have seen, increasing mortality and complications, as expected, among those with sugar in the blood, but we also saw a modest increase in the risk of death in people with very low levels of sugar in the blood" said the senior study author Elbert Huang MD, Professor of medicine at the University of Chicago. Researchers have noted that the best overall results were found among those with intermediate levels of control
Huang and Andrew Karter, Ph.d., Division of research, Kaiser Permanente in Oakland, California, jointly conducted the study of diabetes and aging, the largest observational study to evaluate the United States diabetes in older adults. The 5 Year study, is funded by the NIH for investigating the results of health and care in the patients with diabetes type 2 on a typical community.
More recent guidelines suggested to keep blood glucose in patients with diabetes fairly low. For people without diabetes, normal glucose levels - measured by a test called Hemoglobin A1C, reflecting the level of glucose - average blood in the past three months is between 4 and 6%, compared to 6 and higher for patients with diabetes.
Because of high levels are associated with this chronic disease complications, more recommendations for people with diabetes suggest keep an A1C below 7 percent
"We have more evidence about how well the guideline of 7%, which was based on a British trial of 1998 which excluded older patients, applies to patients over 60 years," co-author of the study, Andrew j. Karter Ph.d. and principal investigator of the study on the research of the Division of Kaiser Permanente, said.
Recent studies have raised concerns. In 2008, the action of the control risk test cardiovascular diabetes (Agreement) has been arrested after showed a rate of mortality in elderly patients who received intensive treatment of decrease in glucose.
"In" our study, said Huang, "we find the best results for General among those with intermediate levels of control, the A1Cs below 8 per cent, but more than 6 per cent". "We see patterns similar to those in the 1960s, 1970s and 1980s years more."
Find the best destination of HbA1c as a balancing act number, take account of the authors. The risk of complications all increases with the level of sugar in the blood, but those with an A1C between 6% and 8% had lower rates of death. While those of sugar in the blood very poorly controlled - A1C over 10 per cent - had the highest rates of death, those with a less than 6 A1C also were a little higher than the with the rate of HbA1c 6 8 per cent.
Karter explained that "we cannot say if this unexpected finding is the own very low sugar in the blood, the treatments used for the control of blood sugar, or other factors not directly related to diabetes care". "It is possible that more ill patients at high risk of dying had low sugar in the blood, more than what either directly related to care of diabetes increases the risk of death".
Additional research, added, "will focus on the identification of the mechanisms underlying the slightly higher mortality in people with very low A1C."
Since 1993, researchers involved in the Northern California Kaiser Permanente diabetes register has collected many of epidemiological data on diabetes care and observe the results of health. The study of diabetes and aging follows patients administered by Kaiser medical care have internal guidelines that reflect national clinical practice. Patients are achieving various levels of glucose control. These studies of the add-in community clinical trials measure if the benefits of the treatments in an experimental environment are also observed in the practice workplace.
Institute of diabetes, digestive diseases supports research and kidneys. Additional authors include Jennifer y Liu, MPH and Howard h. Moffet, MPH, Research Division, Kaiser Permanent in Northern California; and the article by Priya M John, MPH, General internal medicine, the University of Chicago.
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