Managing Risks, Gaining Life in Type 2 Diabetes

Four Ages in LifeThe problem with doing things to prolong your life is that all the extra years come at the end, when you’re old. Bob Mankoff captured this fundamental quandary in a New Yorker cartoon years ago. But the problem of managing health and risks remains on our minds nonetheless. So a new study in JAMA Network Open might help with thinking about managing the risks of type 2 diabetes. Hamed Kianmehr and colleagues provide a thoughtful analysis of the extra years of life associated with managing key risk factors. These are BMI, HbA1c, blood pressure, and LDL cholesterol.

BMI and HbA1c emerged from this analysis as the risks associated with the biggest gains in life expectancy for persons with type 2 diabetes managing them well. For each of these, the researchers found an association with almost four extra years of life.

A Modeling Study

It’s important to note that these data come from a modeling study. Not new experimental research. So, as with any modeling study, we take it with a grain of salt. All models are wrong, but some are useful. (Thank you, George Box.) The value of a good model, such as this one, is that it helps us think about a problem.

This model certainly does that. But as we think about the potential benefits of managing these risks of type 2 diabetes, we should put them in perspective.

Fixating on a Singular Measure

Fixating on a singular measure – whether it’s BMI or HbA1c – brings its own issues. Excessive preoccupation with HbA1c can bring problems, as René Rodriguez-Gutierrez recently explained:

“Intensive glycemic control does, however, increase the risk of severe hypoglycemia and incurs additional burden by way of polypharmacy, side effects, and cost.”

These authors suggest a more holistic approach, aligning targets for HbA1c with a person’s goals and situations. Likewise, while BMI can be a useful marker for clinical risks and progress, it should not stand alone as a substitute for a more complete assessment of a person’s health and personal priorities.

Understanding this makes the difference between actual clinical care and cookbook medicine.

Click here for the new study by Kianmehr et al, here and here for further perspective. For related perspective on lifespan and healthspan, click here.

Four Ages in Life, painting by Edvard Munch / WikiArt

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April 19, 2022