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Hba1c Reduction With Metformin

Long-term Effect Of Metformin On Blood Glucose Control In Non-obese Patients With Type 2 Diabetes Mellitus

Long-term Effect Of Metformin On Blood Glucose Control In Non-obese Patients With Type 2 Diabetes Mellitus

Go to: Abstract We aimed to investigate the long-term effect of metformin on the blood glucose control in non-obese patients with type 2 diabetes mellitus. A retrospective study was performed in 213 patients with type 2 diabetes mellitus under the administration of metformin for more than one year. The clinical parameters were investigated for 3 years. The obese and non-obese individuals were defined as a body mass index (BMI) of 25 kg/m2 or over (n = 105) and a BMI of less than 25 kg/m2 (n = 108), respectively. HbA1c levels were significantly decreased compared with those at the baseline time. The course of HbA1c was similar between the non-obese and the obese groups, while the dose of metformin required to control blood glucose was significantly lower in the non-obese group than in the obese group. The reductions in HbA1c were 1.2% and 1.1% at 12 months, 0.9% and 0.9% at 24 months, and 0.8% and 1.0% at 36 months in the non-obese and obese groups, respectively. BMI did not change during the observation periods. Approximately half of all patients required no additional antidiabetic agents or a reduction in other treatments after the initiation of metformin in either of the two groups. The present study demonstrated the long-term beneficial effect of metformin in non-obese (BMI < 25 kg/m2) diabetic patients. This effect appears to be maintained even after the observation period of this study, because metformin was limited to a relatively low dose in the non-obese group and the observed worsening in glycemic control over time can probably be attenuated by increasing the dose of metformin. Go to: Background Metformin, one of the biguanide agents, has been recommended for the treatment of patients with type 2 diabetes mellitus according to the consensus algorithm published Continue reading >>

Effect Of Metformin Glycinate On Glycated Hemoglobin A1c Concentration And Insulin Sensitivity In Drug-naive Adult Patients With Type 2 Diabetes Mellitus

Effect Of Metformin Glycinate On Glycated Hemoglobin A1c Concentration And Insulin Sensitivity In Drug-naive Adult Patients With Type 2 Diabetes Mellitus

Go to: Abstract This study evaluated the effect of metformin glycinate on glycated hemoglobin A1c (A1C) concentration and insulin sensitivity in drug-naive adult patients with type 2 diabetes mellitus (T2DM). A randomized, double-blind, placebo-controlled clinical trial was carried out in 20 patients with drug-naive T2DM. Ten subjects received metformin glycinate (1,050.6 mg) once daily during the first month and force-titrated twice daily during the second month. Ten additional patients received placebo as the control group. Before and after the intervention, metabolic profile including A1C and insulin sensitivity (euglycemic-hyperinsulinemic clamp technique) was estimated. A1C concentrations decreased significantly with metformin glycinate administration (8.0±0.7% vs. 7.1±0.9%, P=0.008) before and after the intervention, respectively. There were significant differences in changes from baseline of A1C between groups (0.0±0.7% vs. −1.0±0.5% for placebo and metformin glycinate groups, respectively; P=0.004). A reduction of ≥1% in A1C levels was reached in 60.0% of patients with metformin glycinate administration (P=0.02). Insulin sensitivity was not modified by the intervention. Administration of metformin glycinate during a 2-month period showed a greater decrease in A1C concentrations than placebo in a selected group of drug-naive adult patients with T2DM. Go to: In accordance with several algorithms for the medical treatment of patients with type 2 diabetes mellitus (T2DM), metformin hydrochloride along with lifestyle changes is the first line of treatment to achieve metabolic goals and, in combination with other oral agents or insulin, provides an efficacious therapeutic option.1,2 Metformin is a biguanide that activates the 5′-AMP-activated protein kinase Continue reading >>

The Change In Hba1c Associated With Initial Adherence And Subsequent Change In Adherence Among Diabetes Patients Newly Initiating Metformin Therapy

The Change In Hba1c Associated With Initial Adherence And Subsequent Change In Adherence Among Diabetes Patients Newly Initiating Metformin Therapy

The Change in HbA1c Associated with Initial Adherence and Subsequent Change in Adherence among Diabetes Patients Newly Initiating Metformin Therapy 1Kaiser Permanente Center for Health Research, Portland, OR 97227, USA 2Merck & Co., Inc., Kenilworth, NJ 07033, USA Received 25 March 2016; Accepted 3 July 2016 Copyright 2016 Gregory A. Nichols et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Whether changes in adherence are associated with changes in HbA1c is assumed but not known. Methods. We conducted a observational study of 2,844 type 2 diabetes patients who initiated metformin as their first antihyperglycemic drug. Using HbA1c measures before, 612 months after, and up to 3 years after metformin initiation, we analyzed HbA1c change as a function of initial adherence and change in adherence. Results. Compared with no adherence, initial adherence of 5079% was associated with an adjusted reduction in HbA1c of 0.45% while adherence 80% was associated with HbA1c reduction of 0.73%. Change from some initial adherence (179%) to total nonadherence was associated with 0.25% increase in HbA1c. Change from some to full adherence was associated with an HbA1c decrease of 0.15%. Those associations were accentuated among patients not in glycemic control: change from some to no adherence was associated with an HbA1c increase of 0.63% and change from some to full adherence was associated with an HbA1c decrease of 0.40%. Conclusions. Initial adherence to newly prescribed metformin therapy produces substantial HbA1c reduction. Among those with modest adherence but suboptimal glycemic control, the diff Continue reading >>

Control Of Type 2 Diabetes

Control Of Type 2 Diabetes

Embrace your diabetes Enlarge Haemoglobin, in your blood, joins up with glucose to form the chemical called HbA1c We are learning more about diabetes all the time, and it is becoming clear the harder you work to control your diabetes when it is diagnosed the more benefit you will get in the long term. Complications from diabetes will be prevented or delayed (NEJM 08) (UKPDS 08). Type 2 diabetes is a progressive condition. It is not a 'mild' form of diabetes. The exercise you take and the food you eat need to balance the remaining natural insulin your body makes. This page is designed to give readers an idea how decisions are made concerning their care, but remember every patient is different and advice can vary. Take control....learning how to control type 2 diabetes Your diabetes nurse can teach you the basics, and reading up is helpful. But there are structured diabetes education programs that your doctor must enable you to attend such a course. The programs teach you how to take control of type 2 diabetes, and patients who have attended the program have better diabetic control and fewer problems. Compliance Birmingham meeting 2012: Patients only take half their oral medication. Fixed dose combination tablets would help a little. 10% compliance with multiple drugs. What is happening in type 2 diabetes There are four particular problems. These factors work together to contribute to type 2 diabetes. The factors may be controlled by genes. So your children or brothers and sisters may be affected, and they should take precautions (exercise, healthy diet, not becoming overweight, and not smoking). First, there is a shortage of insulin You may have inherited this condition from your parents. Alternatively, a few people may have had pancreatitis or a bad attack of mumps that Continue reading >>

Metformin: An Old But Still The Best Treatment For Type 2 Diabetes

Metformin: An Old But Still The Best Treatment For Type 2 Diabetes

Go to: Introduction The discovery of metformin began with the synthesis of galegine-like compounds derived from Gallega officinalis, a plant traditionally employed in Europe as a drug for diabetes treatment for centuries [1]. In 1950, Stern et al. discovered the clinical usefulness of metformin while working in Paris. They observed that the dose–response of metformin was related to its glucose lowering capacity and that metformin toxicity also displayed a wide security margin [1]. Metformin acts primarily at the liver by reducing glucose output and, secondarily, by augmenting glucose uptake in the peripheral tissues, chiefly muscle. These effects are mediated by the activation of an upstream kinase, liver kinase B1 (LKB-1), which in turn regulates the downstream kinase adenosine monophosphatase protein kinase (AMPK). AMPK phosphorylates a transcriptional co-activator, transducer of regulated CREB protein 2 (TORC2), resulting in its inactivation which consequently downregulates transcriptional events that promote synthesis of gluconeogenic enzymes [2]. Inhibition of mitochondrial respiration has also been proposed to contribute to the reduction of gluconeogenesis since it reduces the energy supply required for this process [3]. Metformin’s efficacy, security profile, benefic cardiovascular and metabolic effects, and its capacity to be associated with other antidiabetic agents makes this drug the first glucose lowering agent of choice when treating patients with type 2 diabetes mellitus (TDM2). Metformin and pre-diabetes In 2000, an estimated 171 million people in the world had diabetes, and the numbers are projected to double by 2030. Interventions to prevent type 2 diabetes, therefore, have an important role in future health policies. Developing countries are expect Continue reading >>

The Efficacy And Safety Of Liraglutide Added To Metformin In Patients With Diabetes: A Meta-analysis Of Randomized Controlled Trials

The Efficacy And Safety Of Liraglutide Added To Metformin In Patients With Diabetes: A Meta-analysis Of Randomized Controlled Trials

Liraglutide, a glucagon-like peptide (GLP-1) receptor agonist, has showed favorable effects in the glycaemic control and weight reduction in patients with type 2 diabetes mellitus (T2DM). The meta-analysis was to compare the efficacy and safety of liraglutide added to metformin with other treatments in patients with T2DM. A systematic literature search on PubMed, Embase, Web of Science and the Cochrane library databases were performed. Eligible studies were randomized controlled trials (RCTs) of patients with T2DM who received the combination treatment of liraglutide and metformin. Pooled estimates were performed using a fixed-effects model or random-effects model. A total of nine RCTs met the inclusion criteria. Compared with control (placebo, sitagliptin, glimepiride, dulaglutide, insulin glargine, and NPH), liraglutide in combination with metformin resulted in significant reductions in HbA1c, bodyweight, FPG, and PPG, and similar reductions in SBP, and DBP. Moreover, liraglutide combined with metformin did not increase the risk of hypoglycemia, but induced a higher incidence of gastrointestinal disorders. In conclusion, this meta-analysis confirmed the use of liraglutide as add-on to metformin appeared to be effective and safe for patients with T2DM. However, considering the potential limitations in this study, more large-scale, well-conducted RCTs are needed to identify our findings. Type 2 diabetes mellitus (T2DM) is a complex and progressive multi-system disease characterized by declining beta cell function and insulin resistance, which lead to loss of glycemic control and eventual diabetes complications1,2. Lifestyle modifications and metformin have been recommended by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EAS Continue reading >>

Pioglitazone And Metformin Similarly Effective In Reducing Hba1c

Pioglitazone And Metformin Similarly Effective In Reducing Hba1c

Pioglitazone and Metformin Similarly Effective in Reducing HbA1c Dec. 13, 2004 -- Pioglitazone and metformin as monotherapy for type 2 diabetes are similarly effective in reducing hemoglobin A1c (HbA1c), but they have different effects on fasting plasma glucose (FPG) and plasma lipid levels, according to the results of a long-term randomized trial published in the December issue of the Journal of Clinical Endocrinology and Metabolism. Adverse event profiles for the drugs also differ and should also be taken into account when prescribing. "Both -cell dysfunction and insulin resistance are core defects in the progression of type 2 diabetes and the associated metabolic syndrome," write G. Schernthaner, MD, from the Department of Medicine I at Rudolfstiftung Hospital in Vienna, Austria, and colleagues. "Pioglitazone reduces insulin resistance by enhancing the action of insulin, thereby promoting glucose utilization in peripheral tissues, suppressing glucogenesis, and reducing lipolysis." The investigators compared the effects of monotherapy in 1,194 therapy-naive patients with poorly controlled type 2 diabetes (mean HbA1c, 7.5% - 11%; reference range was defined as 4.3% - 6.1%) randomized to receive either pioglitazone (up to 45 mg/day; n = 597) or metformin (up to 850 mg three times daily; n = 597) for one year. For the patients who finished the study (499 in the pioglitazone group and 501 in the metformin group), results at 52 weeks showed similar efficacy between the groups in reducing mean HbA1c from baseline (-1.41% for pioglitazone vs -1.50% for metformin). In both groups, maximal effect was observed at 32 weeks and maintained thereafter. However, pioglitazone therapy resulted in significantly greater mean reductions in FPG from baseline compared with metformin (-45. Continue reading >>

Achieving Low Hba1c Levels Benefited Metformin Initiators

Achieving Low Hba1c Levels Benefited Metformin Initiators

Achieving Low HbA1c Levels Benefited Metformin Initiators Achieving Low HbA1c Levels Benefited Metformin Initiators After controlling for baseline HbA1c and other confounders, researchers examined rates of MI, stroke, and death. New results published in Diabetes Care suggest that a large, initial reduction in hemoglobin A1c (HbA1c) and achievement of low HbA1c levels 6 months after metformin initiation lowered the risk for cardiovascular events and death in patients with type 2 diabetes. The population-based cohort study included 24,752 individuals (median age, 62.5; 55% men) with type 2 diabetes who initiated first-time ever metformin treatment. All metformin initiators had HbA1c tests in Northern Denmark between 2000 and 2012. Six months after initiation, the researchers classified patients according to achieved HbA1c level and magnitude of HbA1c change from pretreatment baseline. After controlling for baseline HbA1c and other confounders, researchers examined rates of myocardial infarction, stroke, and death. During follow-up (median 2.6 years), the risk for a combined outcome event increased as achieved HbA1c levels increased. Specifically, compared with a target HbA1c of <6.5%, the adjusted hazard ratio (HR) for an HbA1c of 6.5% to 6.99% was 1.18 (95% CI, 1.07-1.30); for 7% to 7.49% it was 1.23 (95% CI, 1.09-1.40); for 7.5% to 7.99% it was 1.34 (95% CI, 1.14-1.57); and for 8% it was 1.59 (95% CI, 1.37-1.84). Results did not differ for individual outcome events and were robust by age group and other patient characteristics, according to the researchers. In addition, the researchers analyzed the impact of absolute reductions of HbA1c compared with no HbA1c change, and reported the following: -4 absolute reduction: HR, 0.80 (95% CI, 0.65-0.97) -3 absolute reduction: Continue reading >>

New Study Showed Significant Reduction In Blood Glucose With Linagliptin Alone And In Combination With Metformin In Adults Newly Diagnosed With Type 2 Diabetes

New Study Showed Significant Reduction In Blood Glucose With Linagliptin Alone And In Combination With Metformin In Adults Newly Diagnosed With Type 2 Diabetes

New study showed significant reduction in blood glucose with Linagliptin alone and in combination with metformin in adults newly diagnosed with Type 2 Diabetes • Study showed significant reductions of HbA1c up to 2.8 percent  in treatment-naïve adults with uncontrolled Type 2 Diabetes and marked hyperglycaemia (HbA1c >8.5 percent) • Linagliptin monotherapy and in combination with metformin was well tolerated with no significant adverse events • No weight gain seen with linagliptin monotherapy; average weight loss of 1.1kg seen in combination therapy with metformin Ingelheim, Germany and Indianapolis, US, 03 December 2013 – Boehringer Ingelheim (BI) and Eli Lilly and Company today announced new data1 from a Phase IV study evaluating linagliptin (5 mg) as monotherapy and in combination with metformin (1500 or 2000 mg) in treatment-naive adults with newly diagnosed (<12 months) uncontrolled Type 2 Diabetes (T2D). The result showed that linagliptin as monotherapy or in initial combination with metformin achieved clinically significant improvements in glucose control in patients with newly diagnosed T2D and marked hyperglycaemia. Results also showed both treatments provided statistically significant reductions in blood glucose levels, with the combination therapy having greater glucose reduction compared to monotherapy. The results were presented during the 2013 World Diabetes Congress, which is being held 2-6 December in Melbourne, Australia. The study randomised 316 adults with a mean average plasma glucose concentration (HbA1c) of 9.8 percent to receive linagliptin 5 mg once-daily (n = 157) and the initial combination of linagliptin 5 mg once-daily plus metformin twice-daily (uptitrated to a maximal dose of 2000 mg/d; n = 159) for 24 weeks. The results show Continue reading >>

:: Dmj :: Diabetes & Metabolism Journal

:: Dmj :: Diabetes & Metabolism Journal

In reducing microvascular and macrovascular diabetic complications, there has been little controversy on the need for early intensive glycemic control in subjects with newly detected type 2 diabetes (T2D) since the late 1990s [ 1 ]. This consensus is essentially based on the results of controlled clinical trials, such as the Kumamoto study and UK Prospective Diabetes Study, which are prospective randomized studies including a large number of Asian and Western subjects, respectively [ 1 - 3 ]. However, optimal or recommended regimens regarding the selection of hypoglycemic agents to effectively and safely achieve good glycemic status have differed slightly between several guidelines [ 4 - 6 ]. In 2011, the Korean Diabetes Association recommended Clinical Practice Guidelines for T2D in Korea [ 5 ]. This guideline recommended lifestyle interventions with metformin as an initial treatment regimen. In addition, initial treatment with a combination of oral hypoglycemic agents (OHAs) or insulin was also recommended at a hemoglobin A1c (HbA1c) level greater than 8.0% at the time of T2D diagnosis. In the same year, the National Health Insurance Corporation (NHIC) established guidelines to enforce metformin-preferred monotherapy as a general initial treatment regimen and metformin-based dual therapies with sulphonylurea (SU), pioglitazone, or DPP4-inhibitor as an initial regimen at an HbA1c level greater than 7.5%. Recently, Yoon et al. [ 7 ] reported a reduction in HbA1c level after conducting a double-blind, randomized controlled study over a 48-week period on the efficacy of glimepiride, metformin, and rosiglitazone as antidiabetic monotherapies in drug-nave, Korean T2D patients. The study showed no statistical difference in the efficacy of glimepiride, metformin, and rosigli Continue reading >>

Metformin | Diabetesnet.com

Metformin | Diabetesnet.com

Thu, 11/18/2010 - 15:57 -- Richard Morris Two drugs from the biguanide class, metformin and phenformin, were developed in 1957. Unfortunately, phenformin reached the U.S. market first and resulted in several deaths from lactic acidosis. When this risk surfaced, phenformin was pulled from drugstore shelves worldwide. Metformin was eventually found to be 20 times less likely to cause lactic acidosis, but it was tainted by the history of its cousin. Metformin first became available in France in 1979 and has been widely used in Europe since then, but it was not cleared for use in Type 2 diabetes in the U.S. until 1994. Target Organ: Liver, secondary effects on muscle and fat. Action: Lower glucose production by liver, increase number of insulin receptors Side Effects: bloating, fullness, nausea, cramping, diarrhea, vit B12 deficiency, headache, metallic taste, agitation, lactic acidosis Contraindications: DKA, alcoholism, binge drinking, kidney or liver disease, congestive heart failure, pregnancy, use of contrast media, surgery, heart attack, age > 80 Metformin is a chemical kin to the French lilac plant, which was noted in the early 1900’s to lower the blood sugar. However, French lilac, like phenformin, turned out to be too toxic for use in humans. Metformin, with a much shorter action time than phenformin, has a much lower risk for severe side effects and is quite safe for use by anyone who is otherwise healthy. In fact, in the major UKPDS study, it was the only drug that reduced diabetes-related death rates, heart attacks, and strokes. It should not be used by those who use more than two ounces or two drinks of alcohol a day, who have congestive heart failure, or who have significant kidney, liver, or lung disease. Metformin lowers fasting blood glucose levels by an Continue reading >>

Acarbose Cuts Hba1c On Par With Metformin

Acarbose Cuts Hba1c On Par With Metformin

Patients with newly diagnosed type 2 diabetes had similar improvement in glycemic control whether treated with acarbose (Precose) or metformin, investigators in a randomized trial reported. After 48 weeks of treatment, the acarbose group had a mean reduction in glycated hemoglobin (HbA1c) of 1.11% compared with 1.12% for the metformin groups. A between-group difference of 0.02% was observed after 24 weeks of follow-up. Patients in the two treatment groups had identical rates of hypoglycemia and serious adverse events, Wenying Yang, MD, of China-Japan Friendship Hospital in Beijing, and co-authors reported online in The Lancet Diabetes-Endocrinology. "This study is the first head-to-head comparison of metformin and acarbose as initial therapy for type 2 diabetes after failure of therapeutic lifestyle modification," the authors concluded. "We report that both acarbose and metformin are well tolerated and have similar efficacy as initial therapy for HbA1c reduction in Chinese patients with type 2 diabetes." "Metformin should remain as first-line treatment for patients with newly diagnosed type 2 diabetes, while patients with exaggerated postprandial excursion can be treated with an alpha-glucosidase inhibitor as an alternative therapy before cardiovascular benefits of acarbose are validated and confirmed in ongoing studies," they added. The alpha-glucosidase inhibitor acarbose has approval for treatment of type 2 diabetes as an adjunct to diet and lifestyle management. Both acarbose and metformin are widely used as treatment for type 2 diabetes, and acarbose, in particular, is used extensively in China and other Asian countries, the authors noted in their introduction. In contrast, metformin has been used primarily in white populations, and the results have been extrapolat Continue reading >>

Early Hba1c Benefits From Metformin Lowers Risk Of Cardiovascular Events

Early Hba1c Benefits From Metformin Lowers Risk Of Cardiovascular Events

Early HbA1c benefits from metformin lowers risk of cardiovascular events Early HbA1c benefits from metformin lowers risk of cardiovascular events Greater fresh fruit consumption could lower type 2 diabetes rates and diabetes complications 12 April 2017 People with type 2 diabetes who begin metformin treatment and achieve better HbA1c levels within six months are less likely to experience cardiovascular events or death, a new study finds. Scientists from Aarhus University Hospital in Denmark also found that failure to achieve significant HbA1c improvements during the time was a predictor for increased risk of cardiovascular complications . "Among patients with type 2 diabetes who initiate their first metformin treatment, achievement of good early glycemic control and large HbA1c reduction predicts decreased risk of CV outcomes and death," lead researcher Reimar Wernich Thomsen, MD, PhD told Endocrine Today. "Poor early glycemic response provides an important prediction tool for identification of patient subgroups with type 2 diabetes who have increased risk for CV complications and death." A total of 24,572 people with type 2 diabetes who took metformin were involved in this research between 2000 and 2012. All participants were aged over 30 years. Participants were classified by HbA1c levels of 47.5 mmol/mol (6.5%) at six months after initiation of metformin, with the average follow-up time 2.6 years. Those who achieved HbA1c levels lower than 47.5 mmol/mol had the lowest risk of myocardial infarction , stroke or death. Participants with HbA1c levels of 63.9 mmol/mol (8%) had the highest risk. The greatest cardiovascular benefits were observed among participants who had the largest HbA1c reductions, with researchers now looking to analyse the mechanics of this associati Continue reading >>

A1c Reduction Vs Metformin

A1c Reduction Vs Metformin

I was wondering if anybody can confirm what I heard from my cardiologist. He said that 1000 mg metformin would make for 0.5 a1c reduction. I am 44 and 198 pounds. Still about 5-10 pounds in the wrong direction When I was diagnosed Type 2 in Dec 2010. My A1C was 10.7 and my weight 237 pounds. Started with 1000 mg metformin/20 mg simvastatin. Thru exercise/healthy eating my last A1C 2m ago was 5.5 and cholesterol was normal (70ish). Since last couple of months I went to 500 mg metformin and 2.5 mg simvastatin (been decreasing simvastatin gradually in 2011.) Basically, my belief is that diet/exercise/low stress would heal better than drugs and I want to get off metformin and simvastatin altogether. I typically do 30 min cardio in the morning, take 9 floors (210 steps) to my office at lunch time, and series of pushups and situps at night 6 days a week. I found 1000 mg of metformin was not enough for me. Over the past few years I have raised it to the max- 25550 mg. That keeps my bgs close to 100 most of the day. I let myself go to 110-120 after meals but prefer to be close to 100. I do about an hour-90 minutes of exercise most days, mostly walking. I lost weight for about 3 years but have been at 120-124 for about 2+ years. I would like to lose another few pounds but my body seems happy with my body set point. I was on a statin for about 15 months but it started to destroy my muscles so I stopped it. So far the Metformin has no side effects except good bgs and it actually helps in other ways, so I think I will stay on it although my bgs are good. When I was dx'd my bgs were in the 200-300 range and HbA1c was almost 11. So I have seen almost a 6 point drop. Although I have lost close to 30 pounds I was not overweight, high end of normal to start. 115 pounds, Breast Cancer d Continue reading >>

Large, Early Hba1c Reduction Lowered Risk For Cvd Events, Death

Large, Early Hba1c Reduction Lowered Risk For Cvd Events, Death

Large, early HbA1c reduction lowered risk for CVD events, death Medical Economics Blog , Medical Economics Blog , Modern Medicine Cases , Modern Medicine Feature Articles , Modern Medicine News , Modern Medicine Now Top Story , Category-47287 , Diabetes Diagnosis Treatment A study of patients with type 2 diabetes showed that after initiation of treatment with metformin, achievement of good early glycemic control and large HbA1c reduction were important predictors of decreased risk of cardiovascular outcomes and death. Previous studies have pointed towards some benefit for early intensive glycemic control on cardiovascular outcomes, in particular myocardial infarction, but the exact association is disputed, Reimar W. Thomsen, PhD, of the department of clinical epidemiology for the Institute of Clinical Medicine at Aarhus University Hospital in Aarhus, Denmark, told Medical Economics. The definitive relationship between early achieved HbA1c level after glucose-lowering drug start, or the magnitude of early HbA1c reduction achieved, and subsequent long-term risk of CVD outcomes and death in a real-world setting has never been investigated thoroughly. The study, published in Diabetes Care, included all metformin initiators with HbA1c test in Northern Demark from 2000-2012 (n=24,752). Six months after metformin initiation, the researchers classified patients by whether or not they achieved an HbA1c of 6.5% and by the magnitude of HbA1c change from baseline. The median age of patients was 62.5 years and the median follow-up was 2.6 years. We found that risk for a combined measure of death, myocardial infarction and stroke gradually increased with rising levels of achieved HbA1c, compared to a stringent target of <6.5%, Thomsen said. Individual outcome events followed a simil Continue reading >>

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