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HBA1c and mortality in people with newly diagnosed type 2 diabetes

The benefits of tight glycaemic control in people with newly diagnosed type 2 diabetes need to be clarified. In a study using data from the UK GPRD on a group of people with newly diagnosed type 2 diabetes that was published in the British Journal of Diabetes & Vascular Disease, Kamlesh Khunti and colleagues examined the effect of HbA1C on all cause mortality, and also in relation to the presence of cardiovascular disease.

They found differing mortality risks in individuals with and without cardiovascular disease before diagnosis of type 2 diabetes (median survival 15.8 years and 9.8 years respectively). A baseline HbA1C above 6.0% and less than 6.5% was associated with increased all cause mortality in people newly diagnosed with type 2 diabetes without prior cardiovascular disease. In individuals with established cardiovascular disease, HbA1C category levels above 6.5% were associated with a non-significant increase in mortality and only become significant at HbA1c levels above 8.0%. There was also an increased risk of mortality with HbA1C below 6.0%, but this needs further exploration.

Kamlesh Khunti and colleagues concluded that a HBa1c target between 6.0 and 6.5% is appropriate for people newly diagnosed with type 2 diabetes without cardiovascular disease. However, a target of HbA1C < 8.0% may be less beneficial in individuals with established cardiovascular disease.

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