In type 2 diabetes, reduced risk factors mean a longer life

For people with type 2 diabetes, reducing four risk factors – A1c, body mass index (BMI), systolic blood pressure and low-density lipoprotein (LDL) cholesterol – can add months to years of life. life expectancy, according to a new modeling study. .

The results were published online April 18 in Open JAMA Network by Hamed Kianmehr, PhD, Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, and colleagues.

Using trial data to project long-term health outcomes, Kianmehr and colleagues quantified the length of lifespan gained as a function of age, baseline levels of the four risk factors, and the degree of reduction of these. factors.

“Better biomarker control has the potential to increase life expectancy by 3 years in the average person with type 2 diabetes in the United States. For people with very high levels of A1c, systolic blood pressure, LDL cholesterol and BMI, monitoring of biomarkers can potentially increase life expectancy by more than 10 years,” write Kianmehr and colleagues.

The study report includes a heat map of estimated years of life remaining by age and risk factor level that can be used as a clinical reference to support shared decision-making with patients. “Our results can be used by clinicians and patients to select optimal treatment goals, to motivate patients to achieve them, and to measure the potential health benefits of interventions and programs aimed at improving diabetes care in the states. United,” they say.

The Building, Relating, Assessing, and Validating Outcomes (BRAVO) risk engine is a validated simulation model recently developed using data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and calibrated for the general population of the states States using data from the National Health and Nutrition Review Survey.

The study included 421 adults aged 51 to 80 with type 2 diabetes without cardiovascular disease, 46% of whom were women.

Superior blood sugar lowering benefit with a higher baseline

Overall, a reduction in A1c from the highest quartile (mean 9.9%) to the lowest quartile (5.9%) was associated with 3.8 additional years of life. And the reduction in A1c from the highest quartile to the second (average of 7.7%) was associated with an average of 3.4 years of life gained.

However, a further reduction in A1c of 7.7% to the second lowest quartile (mean 6.8%) added only about 6 months of life, while an even larger reduction 6.8% in the lowest quartile added no additional years of life.

This finding was consistent with the ACCORD trial, in which the intensive glycemic group (target A1c Medscape Medical News.

However, only a small proportion of ACCORD participants were taking glucagon-like peptide 1 (GLP-1) receptor agonists and none were taking sodium-glucose cotransporter-2 (SGLT2) inhibitors, note Kianmehr et al. colleagues. “Whether intensive target achievement with these new drugs may produce results different from the ACCORD trial is of great interest to the diabetes community…While we await such evidence, our study highlights the importance of controlling A1c levels between 7.0% and 8.0%,” they write.

Reducing body weight is a ‘clinical and public health priority’

Reductions from highest BMI quartile (mean 41.4 kg/m2) to third (33.0 kg/m2), second (28.6 kg/m2), and the first (24.3 kg/m2) quartiles were associated with 2.0, 2.9, and 3.9 additional years of life, respectively.

“Thus, reducing body weight in people with diabetes and obesity continues to be a clinical and public health priority,” the authors write.

Less impactful, but still significant systolic blood pressure lowering

Compared to individuals in the fourth quartile for systolic blood pressure (160.4 mmHg), reductions in the third (139.1 mmHg), second (128.2 mmHg), and first (114.1 mmHg) quartiles were associated with years of life gained of 1.1, 1.5, and 1.9 years, respectively.

Just because the impact of lowering the fourth to first quartile for systolic blood pressure was less than that for A1c or BMI doesn’t mean blood pressure control isn’t important, point out. the authors, because “our population-level estimates are not designed for clinicians to prioritize one treatment over the other because treatment outcomes vary widely based on individual patient characteristics. »

In addition, “controlling systolic blood pressure saves money from a public health perspective. The relatively lower cost of antihypertensive drugs and the strong causal relationship established between systolic blood pressure and macrovascular complications make systolic blood pressure control of high clinical and economic value.”

For LDL cholesterol, the decline from the fourth quartile (146.2 mg/dL) to the third (107 mg/dL), second (84.0 mg/dL) and first (59 mg/dL) quartiles was associated at 0.5, 0.7, and 0.9 additional years of life, respectively.

The earlier risk factors are addressed, the better

The heat map used shades of red (shorter life expectancy), orange (intermediate life expectancy), and yellow (longer life expectancy) to show the effects of age and gender on overall biomarker results. For example, a 50-60 year old woman with a BMI of 30 kg/m2a systolic blood pressure of 160 mmHg and an A1c level of 10% can add 3 years to his life by reducing his systolic blood pressure to 120 mmHg and an additional 1.2 years by lowering his BMI to 25 kg/m2.

And for a 50-60 year old man with a BMI of 35 kg/m2systolic blood pressure 160 mmHg, A1c 8% and LDL cholesterol 130 mg/dL, reducing his BMI by 35 kg/m2 at 30 kg/m2 could add an additional 1.4 years of life. However, a 71-80 year old man with these same biomarker levels could only add 0.6 years by lowering his BMI to 30 kg/m2.

These results underscore the importance of biomarker control at an earlier age and “the potential need for a trade-off between quality of life and treatment of elderly patients when the benefit of biomarker control is limited,” note Kianmehr et al. colleagues.

The study was partially funded by the US National Institutes of Health. Kianmehr did not report any relevant financial relationships.

JAMA Netw Open. Published online April 18, 2022. Full text

Miriam E. Tucker is a freelance journalist based in the Washington, DC area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR’s Shots blog, and Diabetes Forecast magazine. She’s on Twitter: @MiriamETucker.

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