Good talk from one one of the endocrinologists at Truro on hypoglycaemia in the weekly geriatrics meeting. He covered the Trust's hypoglycaemia policy and the challenge of using the Innolet device with only Insulatard available for the elderly. He also gave a good overview of the cardiovascular risk debate.
I like the sentence: "Don't get too A1c lazy or crazy." which one of the students on our course cited from somewhere.
In particular hypoglycaemia was associated with death in both the agressive and standard treatment arms of the ACCORD study.[1]
There seems to be a difference between the early agressive treatment for T2DM in younger patients without established cardiovascular disease and the later agressive 'tightening' of control in older patients with cardiovacular disease.[2]
This supports the practice of avoidance of hypoglycaemia in the elderly - and the relaxation of HbA1c targets.
1. Bonds DE, Miller ME, Bergenstal RM, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ. 2010;340:b4909. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20061358. Accessed February 5, 2010.
2. Weiss IA, Valiquette G, Schwarcz MD. Impact of glycemic treatment choices on cardiovascular complications in type 2 diabetes. Cardiol Rev. 2009;17(4):165-175. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19525678. Accessed June 22, 2011.
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