San Francisco Bay Area resident Patrick Totty writes about his experiences living with type 2 diabetesSee all posts »
Small A1c Drop, Big Life Expectancy Gain
While controversy swirls around what A1c percentage is ideal for type 2s, no one denies that lower is better.
Currently, the recommended A1c target is 6.5%, equivalent to a daily average of140 mg/dL. For older people who’ve been diagnosed for years, the target is 7.0% (about 170 mg/dL), based on the belief that too-stringent control in that age group may invite cardiovascular problems.
But, say your A1c right now is 7.5% or 8.0%. Your goal should be to drop that figure by one percentage point.
In fact, dropping it by even less than a percentage point can have remarkable long-term consequences. A Swedish study tracked more than 12,000 older, poorly controlled type 2s (average age 62) for five years to see what effects reducing A1c percentages would have on mortality risks from all causes.
The group they studied started with an overall baseline A1c of 7.8%. By the end of the study, about half of the patients, thanks to medication therapy, had dropped their average down to 7.0%. The other patient group saw an increase in its average A1c to 8.5%.
Researchers concluded that the group that lowered its A1c’s were 50 percent less likely to die from any cause over a five-year period than the group whose A1c’s had increased. Also, the first group’s likelihood of dying from cardiovascular problems was about 40 percent less.
What’s interesting here is how effective a drop in A1c can be in helping older people increase their odds of survival. The less-at-risk group’s average A1c of 7.0% seems to substantiate the ADA’s long-standing recommendation that 7.0% is a good target for type 2s.
And in light of the intense discussions over how tightly older people should control their blood glucose levels, 7.0% looks doable and beneficial. It may be a “Goldilocks number” that is just right.
Be on the Lookout for Dulaglutide
Eli Lilly & Co. has announced successful Phase III trails of a once-a-week injectible drug called dulaglutide. In head-to-head comparisons with metformin, Januvia, and Byetta, Lilly says dulaglutide outperformed those drugs in lowering A1c’s.
Encouraged by the results, Lilly says it will petition to FDA to allow it to introduce dulaglutide to the U.S. market next year.
The drug is a GLP-1 analog, which works by stimulating insulin production. While Januvia and Byetta are in the same category, Lilly did not test dulaglutide against two other GLP-1’s, Bydureon, a once-weekly injectible, or Victoza, a once-daily injectible.
Dulaglutide’s market appeal will be its convenience and the fact that it has compared well to other very popular and proven drugs. Drawbacks may be users’ forgetfulness—they’re going to have to be very conscious about taking their weekly dose—as well as the drug’s as yet unknown cost.