Relationship of glycaemic control and hypoglycaemic episodes to 4-year cardiovascular outcomes in people with type 2 diabetes starting insulin

AIMS: To examine the relationships between glycated haemoglobin (HbA1c) and cardiovascular (CV) events in people beginning insulin in routine clinical practice in Europe, North America and Asia in a non-interventional study, the Cardiovascular Risk Evaluation in people with Type 2 Diabetes on Insulin Therapy (CREDIT) study. METHODS: Data on 2999 people were collected prospectively over 4 years from physician reports. The primary outcome was the composite of stroke or myocardial infarction (MI) or CV-specific death. Events were blindly adjudicated. The relative hazards of CV events were described from Cox proportional hazards models incorporating patient risk factors, with updated average HbA1c as a time-dependent covariate. The relationship of severe and symptomatic hypoglycaemia (collected during the 6 months before yearly ascertainment) with CV and all-cause mortality was examined. RESULTS: A total of 147 primary events were accrued during up to 54 months of follow-up. In all, 60 CV-specific deaths, 44 non-fatal MIs and 57 non-fatal strokes occurred, totalling 161 events. There was a significant positive relationship between updated mean HbA1c and primary outcome: hazard ratio (HR) 1.25 [95% confidence interval (CI) 1.12-1.40; p < 0.0001]. CV death [HR 1.31 (95% CI 1.10-1.57); p = 0.0027] and stroke [HR 1.36 (95% CI 1.17-1.59); p < 0.0001] were both strongly associated with HbA1c, while MI was not [HR 1.05 (95% CI 0.83-1.32)]. One or more severe hypoglycaemic episodes affected 175 participants, while 1508 participants experienced one or more symptomatic hypoglycaemic events. We found no relationship between severe/symptomatic hypoglycaemic events and CV-specific/all-cause death. CONCLUSIONS: Ongoing poorer glucose control was associated with CV events; hypoglycaemia was not associated with CV-specific/all-cause death

Diet management, lifestyle factors and education needs by target attainment in Italian youth with type 1 diabetes from the Global TEENs study

Background and aims: TEENs is an international, cross-sectional observational study, conducted in 20 countries in order to assess T1D management and psychosocial parameters in 8-25-year-olds (y/o). Data on diet management, lifestyle factors and education needs by target HbA1c attainment from the Italian cohort are reported. Materials and methods: Data were collected at 23 centres by participant interview, medical record review and participant/parent survey from 1,009 Italian youth (46% female) in three age groups: 8-12 y/o (n=330), 13-18 y/o (n=490), and 19-25 y/o (n=189). HbA1c was measured uniformly using A1cNow™ with target HbA1c defined as &lt;7.5% (58 mmol/mol) for ≤18 y/o (ISPAD) and &lt;7% (53 mmol/mol) for &gt;18 y/o (ADA). Results: Overall, 40% of participants met HbA1c targets. Measuring food intake based on experience was the most common method used by all age groups, followed by carbohydrate counting (Table). Of the participants who used carbohydrate counting, a higher percentage met target HbA1c than did not in all age groups, with a significant effect on target attainment due to carbohydrate counting compared with other methods observed in 13-18 y/o (p=0.035). Avoiding sugars was the least common method used in all age groups. Across all age groups, participants who did not undertake any exercise were numerically less likely to reach HbA1c target; on the contrary, participants who exercised 1-2 days/week were numerically more likely to reach HbA1c target. Performing exercise had a significant effect on target HbA1c attainment in 8-12 y/o (p=0.012). The majority of participants were in the underweight/normal body mass index (BMI) category in all age groups, with no clear pattern between BMI class and the proportion of patients reaching HbA1c target. Participants of all ages commonly requested education on diet, carbohydrate counting, how to manage T1D during illness, and how to manage blood glucose levels with exercise. Conclusion: Carbohydrate counting and exercising at least twice per week help to attain HbA1c target across all age groups. Assessment of lifestyle factors suggests that efforts targeting carbohydrate counting and exercise could promote successful health outcomes and help more patients with T1D to reach the recommended HbA1c target. Supported by: Sanof