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Does optimal HbA1c in diabetes differ according to drug treatment? An evaluation of national electronic database in

Sascha Reiff1, Stephen Fava2

  • 1Department for Policy in Health, Malta.

Diabetes & Metabolic Syndrome
|April 3, 2022
PubMed

Insights

In type 2 diabetes, a J-shaped curve links HbA1c to mortality, suggesting lower blood glucose isn't always better. This study explores if hypoglycemia risk explains this link in patients with type 2 diabetes.

Area of Science:

  • Endocrinology
  • Clinical Research
  • Diabetes Management

Background:

  • A J-shaped relationship between HbA1c and mortality is documented in type 2 diabetes.
  • Hypoglycemia risk is the suspected cause for increased mortality at low HbA1c levels.

Purpose of the Study:

  • To investigate the association between low HbA1c and mortality across different diabetes treatment therapies with varying hypoglycemia risks.
  • To test the hypothesis that hypoglycemia risk mediates the link between low HbA1c and increased mortality.

Main Methods:

  • Analysis of a national electronic database including 25,743 patients with type 2 diabetes.
  • Linking patient data with laboratory results and the national mortality register.

Main Results:

  • A J-shaped or U-shaped association between HbA1c and all-cause mortality was observed in the overall cohort.
  • This association was present in patients on metformin monotherapy and metformin-sulfonylurea combination therapy.
  • The J-shaped association was not observed in patients on sulfonylurea monotherapy or insulin.

Conclusions:

  • The J-shaped relationship between HbA1c and mortality in type 2 diabetes is confirmed.
  • Low HbA1c may be detrimental even without hypoglycemia, suggesting an optimal blood glucose level might be slightly higher.
  • Increased mortality with sulfonylureas may not be solely due to hypoglycemia.
Abstract

Keywords:
Drug treatmentHbA1cMortalityType 2 diabetes

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