A1c has been well proven to be a useful test in predicting type 2 diabetes in adults. This longterm, impressive study reveals that A1c could be meaningfully applied in children too. In addition, the test is comparable with fasting and 2 hour load glucose tests.
A group of 2100 children were followed for about 25 years. A1c ≥5.7% predicts 400% increased risk of diabetes in boys and 700% in girls in 10 years.
To act or not to act?
The study shows that implantable CGM is safe and effective. This would be another useful tool, particularly for type 1 diabetes. A group of 71 participants were followed for 180 days.
Blood pressure (BP) control is a critical part of managing patients with type 2 diabetes. Perhaps it is the single most important aspect of diabetes care, which unlike hyperglycemia and dyslipidemia can reduce both micro- and macrovascular complications. Hypertension is more prevalent in individuals with diabetes than general population, and in most cases its treatment requires two or more pharmacological agents (about 30% of individuals with diabetes need 3 or more medications to control BP).
In this article we describe the key evidence that has contributed to our understanding that reduced BP translates into positive micro- and macrovascular outcomes. We review the data supporting current recommendation for BP target < 130/80 mmHg. Two studies suggest that a lower BP goal could be even more beneficial. We also present the comparative benefits of various antihypertensive drugs in reducing diabetes-related micro- and macrovascular complications.
Finally we propose an evidence-based algorithm of how to initiate and titrate antihypertensive pharmacotherapy in affected individuals. Overall, achieving BP < 130/80 mmHg is more important than searching for the “best” antihypertensive agent in patients with diabetes.
In LEAD-6 trial, about 500 patients with type 2 diabetes were followed for 26 weeks. Participants were randomized to receive either Victoza 1.8 mg once daily or Byetta 10 mcg twice daily. Results indicated relative superiority of Victoza over Byetta as shown by improved A1c (-Δ1.1% vs -Δ0.8%) and better convenience and tolerability.
Slightly high blood cortisol (a stress hormone) can cause weight gain, diabetes, insulin resistance, high blood pressure, osteoporosis, and more importantly cardiovascular disease.