Posted Jul 11 , 2017 02:51 AM

Early Glycemic Control and Magnitude of HbA1c Reduction Predict Cardiovascular Events and Mortality: Population-Based Cohort Study of 24,752 Metformin Initiators

Svensson E, et al. Diabetes Care 2017_online April 12

What were the findings (excerpted from the Abstract)?

This study investigated the association of early, achieved A1C level and magnitude of A1C reduction with subsequent risk of cardiovascular events or death in patients with type 2 diabetes who initiate metformin. The study involved a population-based cohort including all metformin initiators with A1C tests in Northern Denmark, 2000–2012. Six months after metformin initiation, they classified patients by A1C achieved (<6.5% or higher) and by magnitude of A1C change from the pretreatment baseline. The authors used Cox regression to examine subsequent rates of acute myocardial infarction, stroke, or death, controlling for baseline A1C and other confounding factors.  A total of 24,752 metformin initiators (median age 62.5 years, 55% males) were included with a median follow-up of 2.6 years.  The risk of a combined outcome event gradually increased with rising levels of A1C achieved compared with a target A1C of <6.5%: adjusted hazard ratio (HR) 1.18 for A1Cs 6.5–6.99%, HR 1.23 for A1Cs 7.0–7.49%, HR 1.34 for A1Cs 7.5–7.99%, and HR 1.59 for A1C >8%. Results were consistent for individual outcome events and robust by age group and other patient characteristics. A large absolute A1C reduction from baseline also predicted outcome.

Why is this important?

A large initial A1C reduction and achievement of low A1C levels within

6 months after metformin initiation are associated with a lower risk of cardiovascular events and death in patients with type 2 diabetes. This data supports early, aggressive treatment, and timely modification of medication dosages, drugs and drug combinations. Medication adherence plays a critical role in the development of clinical inertia (Grant, et al Diabetes Care 30:807–812, 2007), and poor patient self-management behavior increases therapeutic clinical inertia.  We all need to be aware of the need to intensify medication therapy when control is not achieved or not sustained after meeting a goal of therapy.  Working to assure medication and lifestyle adherence can reap big benefits in reducing cardiovascular risk.

Read the Abstract: