Raised Death Risk With Low and High Glycated Hemoglobin

Patients with type 2 diabetes have increased nonfatal complication risk with raising A1C levels

MONDAY, April 25 (HealthDay News) -- The relationship between glycated hemoglobin (A1C) and mortality or complications suggests setting a target A1C level higher than 6 percent, and lower than 8 percent in elderly patients with type 2 diabetes, according to a study published online April 19 in Diabetes Care.

Elbert S. Huang, M.D., M.P.H., from the University of Chicago, and colleagues evaluated the association between baseline A1C levels and subsequent outcomes, including acute metabolic, microvascular, and cardiovascular events, and mortality in 71,092 patients with type 2 diabetes who were part of the Kaiser Permanente Northern California Diabetes Registry. Data were collected from participants aged 60 years or older (average age, 71.0±7.4) from 2004 to 2008.

The investigators found that the average A1C level was 7.0±1.2 percent. The risk of nonfatal complications increased monotonically for A1C levels above 6 percent. A U-shaped relationship was identified between glycemic levels and mortality. Mortality risk was lower for A1C levels between 6.0 and 9.0 percent, and was higher below 6.0 percent and at, or greater than, 11.0 percent. The risk of complication or death was significantly increased with A1C greater than or equal to 8 percent. The data patterns were consistent across age groups.

"Unlike the risk of 'any complication,' the risk of 'any complication or death' significantly increased relative to the reference group after A1C levels exceeded 8.0 percent," the authors write. "Findings for this outcome identify glycemic thresholds that minimize mortality while enhancing quality of life through the prevention of complications."

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