Zu intensive Diabetes Typ2-Behandlung bei älteren Diabetikern: Vorsicht!

[Oregano]

Zu intensive Diabetes Typ2-Behandlung bei älteren Diabetikern: Vorsicht!

More Follow-Up from the ACCORD Trial (general-medicine.jwatch.org/cgi/content/full/2011/302/1)

In the landmark ACCORD trial, 10,000 older patients with long-standing type 2 diabetes were randomized to achieve a target glycosylated hemoglobin (HbA1c) level of <6% or a target of 7% to 7.9%. The study was stopped after average follow-up of 3.5 years, when mortality was significantly higher in the intensive-treatment group than in the standard-treatment group (5% vs. 4%). During further follow-up of 1.5 years, the intensity of glucose-lowering in the intensive-treatment group was relaxed. Now, researchers report outcomes at 5 years (the originally planned study duration).
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Comment: This extended follow-up from ACCORD doesn't change the original message: HbA1c should not be driven lower than 7% in older patients with long-standing type 2 diabetes. The reason for the excess mortality with intensive glycemic treatment remains unknown. The observed detrimental interaction between intensive glucose-lowering and intensive BP-lowering is an interesting hypothesis-generating finding that deserves additional study.

Fazit:
Es hat sich bestätigt, daß die intensive Blutzucker -und Blutdrucksenkung für bei älteren Patienten mit schon länger bestehendem Diabetes Typ 2 nicht zu empfehlen ist.


Grüsse,
oregano