Diabetes Q&A

Intensive Glucose Control Could Increase Mortality Risk

Intensive glucose control, commonly used in patients with type 2 diabetes, could lead to increased risk of mortality, according to a recent study.

In order to characterize the effects of various glucose-lowering regimens with varying risks of hypoglycemia on mortality risk, researchers from Cardiff University examined data from over 300,000 patients with type 2 diabetes prescribed glucose-lowering therapy in monotherapy or dual therapy with metformin between 2004 and 2013.
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Overall, there were 6646 deaths with follow-up of 374,591 years. Hazard ratios for lower (<7%) vs moderate (≥7%, <8.5%) HbA1c were 1.03 for metformin, 1.11 for sulfonylurea, 1.47 for insulin, 1.02 for combined regimens with low hypoglycemia risk, 1.24 in combined regimens with higher hypoglycemia risk excluding insulin, and 1.28 in combined regimens with high hypoglycemia risk including insulin. 

Higher HbA1c levels were associated with higher mortality risk in regimens with low hypoglycemia risk.

"Treatment guidelines generally recommend therapeutic strategies that aim for low levels of glucose control, on the understanding that it reduces risk of macrovascular complications such as coronary artery disease and stroke. Contrary to this belief, our findings show persuasively that there is an association with increased mortality risk and what is considered to be good glucose control, or low HbA1c," the researchers concluded.

—Michael Potts

References:

  1. Currie CJ, Holden S, Jenkins-Jones S, et al. The impact of differing glucose-lowering regimens on the pattern of association between glucose control and survival [published online November 9, 2017]. Diabetes Obes Metab. doi: 10.1111/dom.13155.
  2. Good glucose control could be bad in type 2 diabetes [press release]. Cardiff University. November 15, 2017. https://www.cardiff.ac.uk/news/view/1004909-good-glucose-could-be-bad-in-type-2-diabetes.