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    Early Glycemic Control and Magnitude of HbA1c Reduction Predict Cardiovascular Events and Mortality: Population-Based Cohort Study of 24,752 Metformin Initiators

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    graham64
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    Early Glycemic Control and Magnitude of HbA1c Reduction Predict Cardiovascular Events and Mortality: Population-Based Cohort Study of 24,752 Metformin Initiators

    Post by graham64 on Wed May 03 2017, 22:31

    Abstract

    OBJECTIVE We investigated the association of early achieved HbA1c level and magnitude of HbA1c reduction with subsequent risk of cardiovascular events or death in patients with type 2 diabetes who initiate metformin.


    RESEARCH DESIGN AND METHODS This was a population-based cohort study including all metformin initiators with HbA1c tests in Northern Denmark, 2000–2012. Six months after metformin initiation, we classified patients by HbA1c achieved (<6.5% or higher) and by magnitude of HbA1c change from the pretreatment baseline. We used Cox regression to examine subsequent rates of acute myocardial infarction, stroke, or death, controlling for baseline HbA1c and other confounding factors.

    RESULTS We included 24,752 metformin initiators (median age 62.5 years, 55% males) with a median follow-up of 2.6 years. The risk of a combined outcome event gradually increased with rising levels of HbA1c achieved compared with a target HbA1c of <6.5%: adjusted hazard ratio (HR) 1.18 (95% CI 1.07–1.30) for 6.5–6.99%, HR 1.23 (1.09–1.40) for 7.0–7.49%, HR 1.34 (1.14–1.57) for 7.5–7.99%, and HR 1.59 (1.37–1.84) for ≥8%. Results were consistent for individual outcome events and robust by age group and other patient characteristics. A large absolute HbA1c reduction from baseline also predicted outcome: adjusted HR 0.80 (0.65–0.97) for Δ = −4, HR 0.98 (0.80–1.20) for Δ = −3, HR 0.92 (0.78–1.08) for Δ = −2, and HR 0.99 (0.89–1.10) for Δ = −1 compared with no HbA1c change (Δ = 0).

    CONCLUSIONS A large initial HbA1c reduction and achievement of low HbA1c levels within 6 months after metformin initiation are associated with a lower risk of cardiovascular events and death in patients with type 2 diabetes.

    http://care.diabetesjournals.org/content/early/2017/03/28/dc16-2271

    Any gains from Metformin therapy will soon be lost to those following the standard high carb prescribed diet, low carb can sustain the benefits


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    chris c
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    Re: Early Glycemic Control and Magnitude of HbA1c Reduction Predict Cardiovascular Events and Mortality: Population-Based Cohort Study of 24,752 Metformin Initiators

    Post by chris c on Wed May 03 2017, 23:39

    Agreed, metformin is Good Stuff compared to many of the other drugs but it can't achieve miracles. I'll read the study later. I wonder if it will refer to EPIC-Norfolk or Elley et al (New Zealand) or yet another study I saw recently looking at A1c vs. CVD risk starting from genuinely normal A1c of below 5%, by the time you reach 6.5% risk has increased substantially.

      Current date/time is Wed Jan 24 2018, 03:44