The increased mortality reported with intensive glycaemic control has been attributed to an increased risk of treatment-related hypoglycaemia. This study investigated the relationships of haemoglobin (Hb) A1c, anti-hyperglycaemic treatment, and potential risks of adverse effects with all-cause mortality in patients with type 2 diabetes. Patients (n = 15,773) were stratified into four categories according to baseline HbA1c and then assigned to three target categories, based on whether HbA1c was ≤0.5% below or above (on-target), >0.5% below (below-target) or >0.5% above (above-target) their HbA1c goal, personalized according to the number of potential risks among age > 70 years, diabetes duration > 10 years, advanced complication(s), and severe comorbidity (ies). The vital status was retrieved for 15,656 patients (99.26%). Over a 7.4-year follow-up, mortality risk was increased among patients in the highest HbA1c category (≥8.5%) (adjusted hazard ratio, 1.34 (95% confidence interval, 1.22-1.47), p < 0.001) and those above-target (1.42 (1.29-1.57), p < 0.001). Risk was increased among individuals in the lowest HbA1c category (<6.5%) and those below-target only if treated with agents causing hypoglycaemia (1.16 (1.03-1.29), p = 0.01 and 1.10 (1.01-1.22), p = 0.04, respectively). These data suggest the importance of setting both upper and lower personalized HbA1c goals to avoid overtreatment in high-risk individuals with type 2 diabetes treated with agents causing hypoglycaemia.

Association between on-treatment haemoglobin A1c and all-cause mortality in individuals with type 2 diabetes. importance of personalized goals and type of anti-hyperglycaemic treatment / Orsi, Emanuela; Bonora, Enzo; Solini, Anna; Fondelli, Cecilia; Trevisan, Roberto; Vedovato, Monica; Cavalot, Franco; Zerbini, Gianpaolo; Morano, Susanna; Nicolucci, Antonio; Penno, Giuseppe; Pugliese, Giuseppe. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 9:1(2020), pp. 1-16. [10.3390/jcm9010246]

Association between on-treatment haemoglobin A1c and all-cause mortality in individuals with type 2 diabetes. importance of personalized goals and type of anti-hyperglycaemic treatment

Morano, Susanna;Pugliese, Giuseppe
Ultimo
2020

Abstract

The increased mortality reported with intensive glycaemic control has been attributed to an increased risk of treatment-related hypoglycaemia. This study investigated the relationships of haemoglobin (Hb) A1c, anti-hyperglycaemic treatment, and potential risks of adverse effects with all-cause mortality in patients with type 2 diabetes. Patients (n = 15,773) were stratified into four categories according to baseline HbA1c and then assigned to three target categories, based on whether HbA1c was ≤0.5% below or above (on-target), >0.5% below (below-target) or >0.5% above (above-target) their HbA1c goal, personalized according to the number of potential risks among age > 70 years, diabetes duration > 10 years, advanced complication(s), and severe comorbidity (ies). The vital status was retrieved for 15,656 patients (99.26%). Over a 7.4-year follow-up, mortality risk was increased among patients in the highest HbA1c category (≥8.5%) (adjusted hazard ratio, 1.34 (95% confidence interval, 1.22-1.47), p < 0.001) and those above-target (1.42 (1.29-1.57), p < 0.001). Risk was increased among individuals in the lowest HbA1c category (<6.5%) and those below-target only if treated with agents causing hypoglycaemia (1.16 (1.03-1.29), p = 0.01 and 1.10 (1.01-1.22), p = 0.04, respectively). These data suggest the importance of setting both upper and lower personalized HbA1c goals to avoid overtreatment in high-risk individuals with type 2 diabetes treated with agents causing hypoglycaemia.
2020
hba1c all-cause mortality; adverse treatment effects; hypoglycaemia; type 2 diabetes
01 Pubblicazione su rivista::01a Articolo in rivista
Association between on-treatment haemoglobin A1c and all-cause mortality in individuals with type 2 diabetes. importance of personalized goals and type of anti-hyperglycaemic treatment / Orsi, Emanuela; Bonora, Enzo; Solini, Anna; Fondelli, Cecilia; Trevisan, Roberto; Vedovato, Monica; Cavalot, Franco; Zerbini, Gianpaolo; Morano, Susanna; Nicolucci, Antonio; Penno, Giuseppe; Pugliese, Giuseppe. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 9:1(2020), pp. 1-16. [10.3390/jcm9010246]
File allegati a questo prodotto
File Dimensione Formato  
Orsi_Association-between_2020.pdf

accesso aperto

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Creative commons
Dimensione 1.37 MB
Formato Adobe PDF
1.37 MB Adobe PDF

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1358102
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 4
  • ???jsp.display-item.citation.isi??? 3
social impact