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Type 2 diabetes: avoid intensive treatment

Clinical trials confirm that intensive treatment should be avoided in diabetic patients with a high cardiovascular risk. The aim should be to achieve an HbA1c level no lower than 7% to 7.5%.

The efficacy of treatments for type 2 diabetes is evaluated according to the patient’s HbA1c (or glycated haemoglobin) level, which is a reflection of the average blood glucose level over several weeks.

A publicly financed US study compared two treatments in around 10,000 diabetic patients with a high cardiovascular risk. The different treatments aimed to achieve different HbA1c levels: one below 6%, the other between 7 and 7.9%.

After monitoring the patients for an average of 4 years, the study was halted in February 2008, due to the higher mortality rate in diabetic patients treated intensively.

Other evidence has confirmed that an HbA1c level of between 7% and 7.5% is optimal in terms of preventing diabetes-related complications and mortality.

In practice, when treating type 2 diabetic patients with a high cardiovascular risk, it is better to maintain the HbA1c level at 7 to 7.5 %.

©Prescrire 1 January 2013

"Type 2 diabetes: increased mortality with low HbA1c" Prescrire Int 2013; 21 (134): 23. (Pdf, subscribers only).
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