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Examining the Impact of Intensive Glucose-Lowering Treatment on Hypoglycemia Risk

One of the key indicators in effective diabetes management is HbA1c level. In healthy, non-diabetic adults, the target range is 4% to 5.6%, while in individuals with diabetes, the goal is to maintain an HbA1c level of less than 7%. However, some treatment guidelines aim for achieving levels of 5.6% or less, or between 5.7% and 6.4%.

Striving for these lower HbA1c levels through intensive glucose-lowering therapy may prove more risky than beneficial, though, especially for adults who are considered clinically complex, according to a recent study. These individuals may benefit from less intensive treatment and slightly higher target HbA1c levels to reduce risk of emergency department visits and hospitalizations for severe hypoglycemia.

The study included data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014, and “participants were categorized as clinically complex if 75 years or older or with 2 or more activities of daily living limitations, end-stage renal disease, or 3 or more chronic conditions.” They were considered to be engaged in intensive treatment if their HbA1c level was below 5.6% and they took any glucose-lowering medication, or if their HbA1c level was between 5.7% and 6.4% and they took two or more glucose-lowering medications.

In addition to NHANES data, other population-level studies were included as well when comparing data and outcomes. Overall, overtreatment was estimated to occur in up to 50% of non-clinically complex patients and up to 60% of clinically complex patients.

For the study, 662 nonpregnant adults who had diabetes and maintained HbA1c levels of less than 7.0% were used to represent around 10.7 million adults with diabetes in the United States. Of these participants, 20.1% were age 75 or older, 21.5% were treated intensively, and 32.3% were considered clinically complex. The researchers estimated that over two years, there would be 31,511 hospitalizations and 30,954 emergency department visits for severe hypoglycemia, and that around 4,774 hospitalizations and 4,804 ED visits could be directly attributed to intensive glucose-lowering therapies.

The study found that aggressive treatment of diabetes to achieve lower HbA1c levels could actually have a negative effect on overall health, especially for clinically complex patients who experienced severe hypoglycemic events. It is recommended that many elderly and clinically complex patients avoid intensive treatments and follow relaxed glycemic targets. Recommended HbA1c levels should be evaluated on an individual basis and take into account patient health, comorbidities, and clinical complexity.

There were limitations to this study, and researchers note that “true numbers are likely to much higher” regarding hypoglycemic events and the number that are directly attributable to intensive glucose-lowering therapy.

Type 1 diabetes management is a complex process, and researchers are continually advancing their understanding of the disease and effective treatment options. Diabetes Research Connection (DRC) follows advancements in the field and potential impact on individuals living with T1D.

DRC supports novel, peer-reviewed research studies regarding the diagnosis, treatment, and quality of life for those living with the disease. Learn more about current projects and how to donate to these efforts by visiting http://diabetesresearchconnection.org.

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Structured Mealtime Routines May Help Manage HbA1c Levels in Young Children with Type 1 Diabetes

Managing type 1 diabetes (T1D) can be challenging for anyone, but it can be especially difficult for parents of young children with the disease. They must carefully monitor their child’s diet and activity while regularly checking blood glucose levels. A recent study has found that those children who receive preprandial insulin and eat on a regular schedule tend to have improved HbA1c levels.

Researchers analyzed data from 22 Australian children age seven or younger. Their parents tracked the exact amounts and types of food and beverages offered and consumed by their children over a three-day period. They also answered 16 questions regarding mealtime routines and their child’s eating patterns, such as whether they grazed throughout the day or had set snack times and meal times. In addition, it asked about use of preprandial insulin.

The study found that 95% of children used preprandial insulin, and all children ate at least three meals per day. For 81% of children, their parent determined when they were offered food, but the other 19% followed child-led eating patterns. While there was no direct correlation between carbohydrate, protein, or fat intake on HbA1c, researchers did note that HbA1c levels were lower in those children who ate at regular mealtimes as opposed to grazing throughout the day.

Another interesting note was that the children with T1D ate similar diets as those children without the disease. Furthermore, none of the children in the study met the daily recommended vegetable intake, and only 28% ate recommended amounts of lean meats and protein. Additional research is necessary to evaluate the impact of diet quality on diabetes management.

It is these types of studies that provide further insight into improving management of type 1 diabetes. The Diabetes Research Connection (DRC) provides early career scientists with up to $75K in funding to support peer-reviewed, novel research studies focused on prevention, treatment, and management of type 1 diabetes as well as working toward a cure. To learn more and donate to current projects, visit http://diabetesresearchconnection.org.

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HbA1c Levels May Influence Preterm Birth Risk

Maintaining healthy HbA1c levels is essential for individuals with type 1 diabetes (T1D), but it may be especially critical for women seeking to have children. A recent study out of the Karolinska Institutet in Stockholm found that higher HbA1c levels during the periconceptional period may increase risk of preterm birth.

The study compared incidences of preterm birth for 2,474 babies born to women with type 1 diabetes, and 1,165,216 babies born to women without diabetes. They were all single births; no multiples. The researchers found that, overall, preterm birth occurred in 22.3 percent of babies born to women with T1D verses 4.7 percent of babies to women without diabetes. Broken down even further, the results revealed that the higher the woman’s periconceptual HbA1c level, the higher the risk for preterm birth. When the HbA1c level was below 6.5 percent, there was a 13.2 percent incidence of preterm birth compared to a 37.5 percent incidence when the HbA1c level was at or above 9.1 percent.

However, it is important to note that researchers found, “Preterm birth among women with T1D was strongly linked to periconceptual HbA1c levels, although women whose HbA1c levels were consistent with recommended target values were also at increased risk for preterm birth as well as other adverse pregnancy outcomes.”

This study helps to raise awareness about the risk of preterm birth for women with T1D and the importance of monitoring and managing blood sugar levels. T1D can impact many aspects of an individual’s life, and that includes pregnancy. Gaining a better understanding of these effects can support improved treatment and overall healthcare.

The Diabetes Research Connection (DRC) stays abreast of the latest industry findings and provides critical funding for early career scientists pursuing T1D-related research. Donations from individuals, corporations, and foundations make it possible for these projects to move forward and for innovative research to continue.

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