Achieving T2D Treatment Goals May Extend Life Expectancy

A US decision analytical model suggested that achieving recommended goals of glycated hemoglobin (HbA_1c), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI) may extend the life expectancy (LE) of people with type 2 diabetes (T2D). The model was calibrated to a nationally representative sample of adults with T2D and then used to conduct the simulation experiment on the study population over a lifetime. A total of 421 adults with T2D (46% women, mean age 65.6 years) were grouped into quartiles based on levels of HbA_1c, SBP, LDL-C, and BMI. Compared with a BMI of 41.4 (mean of the 4th quartile), lower BMIs of 24.3 (1st), 28.6 (2nd), and 33.0 (3rd) were associated with 3.9, 2.9, and 2.0 additional life-years, respectively. Compared with an SBP of 160.4 mm Hg (4th), lower SBP levels of 114.1 mm Hg (1st), 128.2 mm Hg (2nd), and 139.1 mm Hg (3rd) were associated with 1.9, 1.5, and 1.1 years gained in LE, respectively. A lower LDL-C level of 59 mg/dL (1st), 84.0 mg/dL (2nd), and 107.0 mg/dL (3rd) were associated with 0.9, 0.7, and 0.5 years gain in LE, compared with LDL-C of 146.2 mg/dL (4th). Reducing HbA_1c from 9.9% (4th) to 7.7% (3rd) was associated with 3.4 years gain in LE. However, a further reduction to 6.8% (2nd) was associated with only a mean of 0.5 years gain in LE, and from 6.8% to 5.9% (1st) was not associated with LE benefit. Overall, reducing HbA_1c from the 4th quartile to the 1st is associated with an LE gain of 3.8 years. The findings are consistent with previous studies and may be helpful in choosing optimal treatment goals for potential benefits in T2D. Source: https://jamanetwork.com/