Real World Blood Sugar Control

HbA1c in type 2 diabetes patients worsened only slightly over the course of five years

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) The main goal of diabetes treatment is to get blood sugar levels under control. From lifestyle changes to prescription drugs, there are a number of ways to manage blood sugar. How well do these methods work?

Over the course of five years, blood sugar levels increased only slightly among type 2 diabetes patients taking metformin, sulfonylureas, or insulin.

However, patients taking insulin had to double their dosage, which increased weight gain and the risk of hypoglycemia (dangerously low blood sugar levels).

"Carefully monitor your blood sugar levels."

Generally, blood sugar control among diabetes patients gets worse over time. As blood sugar worsens, patients often need to strengthen their treatment.

In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial, James D. Best, MD, of the University of Melbourne Medical School, and colleagues took the opportunity to study blood sugar control in a "real-world setting."

They looked at the effects of metformin, sulfonylureas, and insulin on blood sugar control and weight gain.

At the beginning of the study, patients had an HbA1c (a measure of blood sugar over three months) of about 6.9 percent. After five years, HbA1c grew by an average of 0.22 percent.

HbA1c levels tell patients how well they are controlling their diabetes. A healthy adult should have an HbA1c of 5.7 percent or less. When HbA1c levels reach 6.5 percent or higher, a person is said to have diabetes.

When the study began, only two percent of patients were taking oral drugs other than metformin or sulfonylureas. After five years, a similarly low number of patients (four percent) were taking oral drugs other than metformin or sulfonylureas.

After five years, the 855 patients who started taking insulin for the study were able to maintain an HbA1c that dropped from 8.2 percent to 7.7 percent. However, they gained about ten pounds.

As being overweight and obesity are the leading causes of type 2 diabetes, this weight gain is troubling.

"With intensification of traditional therapies, [blood sugar control] deteriorated very little over five years in a large cohort of type 2 diabetes," the authors write. "However, the requirement for insulin therapy doubled, at the expense of significant weight gain and risk of hypoglycemia."

These findings suggest that traditional treatments for diabetes can keep blood sugar levels from worsening over time. Still, insulin treatment can cause some problems, specifically weight gain and drops in blood sugar.

The study - which included 4,900 people with type 2 diabetes - is published in Diabetes Care, a journal of the American Diabetes Association. 

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Review Date: 
June 22, 2012
Last Updated:
November 12, 2012