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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EGlucose levels that deviated from established glycemic targets were found to be associated with an increased risk of mortality in an analysis of self-monitoring blood glucose data from a subset of patients in the ACCORD trial.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Endocrinology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHyperglycemia\/Hypoglycemia\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EGlucose levels that deviated from established glycemic targets were found to be associated with an increased risk of mortality in an analysis of self-monitoring blood glucose (SMBG) data from a subset of patients in the ACCORD trial.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003E\u201cThe more you diverge from what you\u0027re trying to achieve, the higher [the] risk of mortality,\u201d said Richard Bergenstal, MD, International Diabetes Center at Park Nicollet, Minneapolis, Minnesota, USA, who reported the findings.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe subanalysis was done in an effort to better understand the excess mortality that was found with intensive therapy (target HbA1C \u0026lt;6%) compared with standard therapy (target HbA1C \u0026lt;7% to 7.9%) in the ACCORD trial. Increased mortality in the study was found to be associated with severe hypoglycemia, but the risk was similar in both groups and could not account for the difference between the groups. The hypothesis was that mild\/moderate hypoglycemia may be the cause, leading the investigators to study SMBG data.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EApproximately half (52%) of the patients in ACCORD had downloaded any SMBG data; most had downloaded data for at least 2 years. The patients who downloaded SMBG data were representative of the entire study population, as their characteristics were similar to those of the patients who had not downloaded SMBG data.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ESubjects in the intensive group tested their glucose levels more frequently (2.7 vs 2 times per day in the standard group). There was a significant correlation between drop in HbA1C and increasing frequency of SMBG tests for both groups (11% reduction in the intensive group and 6% reduction in the standard group; p\u0026lt;0.001 by rank correlation). This finding suggests that more frequent self-monitoring may be worthwhile.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe frequency of hypoglycemia (glucose level \u0026lt;70 mg\/dL) was 3 times greater in the intensive group than in the standard group, and the frequency of hyperglycemia (glucose level \u0026gt;200 mg\/dL) was 2 times greater in the standard group than in the intensive group. However, patients in the intensive group who died were not more likely to have had hypoglycemia than those who remained alive. Instead, the proportion of patients with glucose levels \u0026gt;140 mg\/dL was higher among the patients who died.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EIn evaluating mortality according to the frequency of hypoglycemia, the highest mortality (more than 5%) was found among patients in the intensive group who had fewer than 1% of low glucose levels; the rate was 5 times greater than that for patients in the standard group with few low levels. In the standard group, the highest mortality was associated with the greatest frequency of hypoglycemia; the rate was nearly twice as high as that for patients in the intensive group with the same percentage of low levels.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EIn terms of hyperglycemia, mortality was highest in both groups when the frequency of high glucose level was greatest; the rate for the intensive treatment group was more than twice that for the standard group.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EDr. Bergenstal recommended setting a glucose goal in addition to an HbA1C goal. \u201cEvaluate the [glucose] profiles, and if you\u0027re not achieving the target you set, then be careful and think about whether you want to intensify treatment further if the levels diverge from [the target].\u201d Clinicians should be careful about even mild to moderate hypoglycemia, particularly in people for whom goals have been relaxed, such as frail older patients.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EHigh HbA1C levels are dangerous, not only because of the risk for hyperglycemia but also because patients with high HbA1C levels had the worst frequency of hypoglycemia.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/8\/11.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn1bd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}