Study backs controversial QOF diabetes targets

Meta-analysis suggests that intensive glucose-lowering targets could cut risk of MI and heart disease.

Intensive glucose-lowering among patients with type-2 diabetes could help to cut MI risk, research shows.

The findings support lower blood glucose targets added to the QOF for 2009/10.

The framework now expects GPs to aim for an HbA1c target of 7 per cent instead of the previous 7.5 per cent.

But experts have warned that the targets endanger patients by increasing the risk of hypoglycaemia (GP, 1 May).

For this study, the researchers carried out a meta-analysis of five studies on 33,040 patients, covering 1,497 MIs, 2,318 cases of coronary heart disease, 1,127 strokes and 2,892 deaths.

Patients receiving intensive treatment had lower HbA1c levels than those given standard treatment (6.6 per cent compared with 7.5 per cent).

Overall, patients on intensive treatment were 17 per cent less likely to suffer an MI. Their risk of developing heart disease also fell by 15 per cent.

Lead researcher Dr Kausik Ray, from Strangeways Research Laboratory in Cambridge, said: 'These data show the tougher QOF targets are correct.

'Our study offers consistent data to show that intensive treatment can reduce the risk of MIs, heart disease and strokes.'

However, it may not be appropriate for some patients, such as the elderly, he added.

Dr Colin Kenny, former chairman of the Primary Care Diabetes Society, said: 'This meta-analysis is useful and partially reassuring to GPs. But it does not convince me to give really tight control to prevent macrovascular disease.'

  • Lancet 2009; 373: 1,765-72

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