Translating “Nondiabetic” A1C Levels to Clinical Practice

Abstract

It is well recognized that there is a significant delay from the time clinical research findings are first reported and when the results become an integral part of clinical care. With the understanding that the prevalence and incidence of diabetes is increasing worldwide, and that the resulting complications are a major contributor to morbidity and mortality, the need for more rapid clinical translation of research findings for diabetes could not be greater. Specifically, a large amount of clinical research data has been reported in the recent past that is of great interest to the provider caring for individuals with diabetes. Much of the emphasis for research has been devoted to understanding the contribution of hyperglycemia and its treatment on macrovascular disease. For example, within the last decade, we have not only recognized the pivotal role that chronic hyperglycemia, as assessed with A1C levels, contributes to the development of microvascular complications, but we have recognized the importance of glycemia in contributing to cardiovascular disease (CVD) (1,2). Observations from large-scale prospective trials over the last couple of years have reported that in high-risk subjects, intensive therapy to lower A1C levels below suggested targets may not be beneficial or may increase mortality (3–5). However, as observed from these studies, we also learned that certain subsets of patients with type 2 diabetes may actually benefit from intensive glycemic control (3). The most recent analysis, reported in May 2010, has now suggested that mortality may actually be greater for those who maintain a higher A1C level despite attempts at intensive glycemic management …