by Colin Kenny, GP, Dromore
In this analysis, the effects of HbA1c reduction on diabetes outcomes and overall quality-adjusted life years were assessed. Outcomes in adults with type 2 diabetes were simulated using relevant data drawn from the National Health and Nutrition Examination Study. Investigators noted that improving glycaemic control could provide substantial benefits, especially for younger people. However, they felt that for most people older than 50 years with an HbA1c level less than 75 mmol/mol (9%) who were receiving metformin therapy, additional glycaemic treatment offered only modest benefits. The investigators also found that an increase in treatment burden meant that HbA1c lowering was associated with more harm than benefit in people aged 75 years.
The need to individulise care in people with diabetes is common to all guidelines and this study confirms that the magnitude of benefit for hypoglycaemic agents is sensitive to individuals’ views of treatment burden. The researchers suggest that the treatment of people with HbA1c levels less than 75 mmol/mol (9%) should be individualised on the basis of estimates of benefit weighed against the person’s views of the burdens of treatment.
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