Sunday, October 07, 2007


We have been waiting for a long time for diabetologist to do clinical trials with hard cardiac endpoints. All of us notice that perhaps with the exception of UKPDS, all diabetic trials have used soft endpoints of Blood sugar levels and HbA1c. I have often commented at clinical meetings that diabetologist like soft endpoints, while we cardiologist like hard clinical end-points of AMI, cardiac deaths or strokes. So it was quite refreshing to read that at the European Association for the Study of Diabetes 2007 meeting, Dr Joseph Thomas of Yale presented a retrospective study of 70,000 diabetics from the Integrated Healthcare Information System, to correlate the adequacy of blood sugar control, as evidence by HbA1c with the incidence of AMI, CABG and Strokes. Of course the correlation was highest with patients whose HbA1c was between 7-9% . Patients with high HbA1c levels had more AMIs, CABG and also strokes. This is not surprising, and nice to know. However, it is important to note that this is a retrospective trials, from essentially registry data, with all its attendant shortcomings. But, it is good to know. Sometimes, whenever I am at diabetic meetings ( and this is getting more frequent nowadays ), I also hear of different schools of diabetologists with different biochemical index of diabetes control. Some like FBG, some 2hrs PP glucose, some HbA1c, some average HbA1c, and others even, average blood glucose. How I wish that diabetologist with standardise their definitions and endpoints of good diabetic control. It is all most confusing.

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