Tight diabetes control early on cuts heart attack risk, Swedish data shows
A two-decade study of 500,000+ Swedish diabetes patients reveals that tight blood sugar control in the first 18 months after diagnosis significantly reduces cardiovascular death and complications. The finding challenges passive management approaches and suggests early intervention could reshape treatment protocols and healthcare costs for the 37 million people globally with type 2 diabetes.
Originaltitel: Impact of early and tight <scp>HbA1c</scp> control on the risk of long‐term complications and cardiovascular death in patients with type 2 diabetes from the Swedish National Diabetes Register
AIMS: To assess the relationship between haemoglobin A1c (HbA1c) levels and incidence of long-term complications in patients with type 2 diabetes (T2D). MATERIALS AND METHODS: This long-term, retrospective study acquired patient data from the Swedish National Diabetes Registry and linked national registers between 1 January 1998 and 31 December 2019. The incidence rates (IR) of microvascular/macrovascular outcomes and cardiovascular death were reported for the overall study population. The hazard ratios (HR) for these outcomes were compared across HbA1c ranges assessed over time and between the early HbA1c control groups: early tight control (HbA1c ≤6.5%), no early tight control (HbA1c >6.5%), and early adverse control (HbA1c >7%), from 18 months after diagnosis. RESULTS: 57.2% of the overall population were male and a median age of 60 years. The IR per 100-patient-years of any microvascular complication remained relatively stable (2005: 8.75; 2014: 10.95; 2019: 8.71), while cardiovascular death increased from 2005 (IR: 0.12) to 2018 (IR: 0.46). Incidences of any macrovascular complication increased with HbA1c ranges (8.0% to <9.0%, HR:1.16 [95%CI: 1.12-1.20]; 7.0% to <8.0%, HR:1.08 [95%CI: 1.05-1.11]) compared to reference (6.0 to <7.0%). Between early HbA1c control groups, the rates of any microvascular/macrovascular complication, and cardiovascular death were reduced in the reference early tight control group compared to the no early tight control group (HR:0.84 [95%CI: 0.80-0.89]; HR:0.86 [95%CI: 0.79-0.93]; and HR:0.60 [95%CI: 0.46-0.79], respectively), with similar results achieved compared to the early adverse control group. CONCLUSIONS: Elevated HbA1c levels were closely associated with long-term complications, while early tight control of HbA1c corresponded to significantly improved clinical outcomes in patients with T2D.