A1c Control for Type 2 Diabetes Patients

Preventing Night-time Hypoglycemic Events
There was an article in the February 5, 2010, issue of the Lancet titled "Manual closed-loop insulin delivery in children and adolescents with type 1 diabetes: a phase 2 randomized crossover trial." The study was done by Dr. Roman Hovorka, PhD et al.

This study compares standard continuous insulin therapy (that is, insulin pump therapy) with a closed-loop therapy. Closed-loop therapy is where the continuous glucose monitor can check and control the amount of insulin given by the insulin pump.

The population for this study was 19 children and adolescents aged 5 years to 18 years. In the study, glucose levels were examined every 15 minutes during the night, and a nurse adjusted the insulin pump as needed. They examined the amount of time it took to adjust the blood glucose levels up or down.

Researchers also measured responses after exercise and after slowly and quickly absorbed meals.

The results indicate there were no night-time hypoglycemic events with the closed-loop therapy, as compared with 9 events for patients using the standard treatment.

So what does that mean? The closed-loop system could reduce the number of night-time hypoglycemic events in children with type 1 diabetes. This is big news for any of us with type 1. Night time can be a very big problem because we can go from deep sleep to seizure and coma with little warning.

We'll keep our eyes open for more information on this research. Remember, this is a phase II trial, and there are 3 trial levels to go through before a treatment receives government approval.

You can read up on this phase II trial here.

Tight A1c Control
That same issue of the Lancet had an article titled "Survival as a function of HbA1c in people with type 2 diabetes: a retrospective cohort study." It is by Dr. Craig J. Curries, PhD et al.

For a number of years, many experts thought that tight control for type 2 diabetes was a very good thing. In the recent past, however, some studies have contradicted this for safety reasons, so this is an interesting article.

This was a large study of 27,965 type 2 diabetes patients whose treatment was one oral medication, and 20,005 patients whose therapy had been modified to a combination therapy that included insulin. Ages were 50 years or older. Researchers look at the decile of A1c levels as compared to mortality, which was presented as a hazard ratio.

The researchers found that the low and high mean A1c were associated with all-cause mortality rates, including cardiac events. The lowest hazard ratio was for an A1c of about 7.5%, so now you have something else to talk over with your physician.

To prepare for talking with your doctor, read the abstract here.

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