By Bill Levesque

GAINESVILLE —  A person struggling to control their Type 2 diabetes might understand in the abstract the impact of the disease on their health. A doctor, for example, might tell them they are two to four times more likely to die of heart disease.

Telling a patient, however, that better controlling blood sugar, or glucose, could add nearly four years to their life — or conversely, that failing to control it will cut life short by four years — packs an emotional punch in its specificity.

University of Florida Health researchers in a modeling study published last month in JAMA Network Open estimates the years that might be added to the life span of someone with Type 2 diabetes with improved control of the disease. The findings, they hope, might motivate patients to follow a healthier lifestyle and help clinicians prioritize interventions, researchers said.

The study focused on four measures commonly used to monitor patients with diabetes: hemoglobin A1c, a measure of blood glucose; body mass index; blood pressure; and low-density lipoprotein, or LDL, cholesterol, also known as “bad” cholesterol.

“Better control of biomarkers can potentially increase the life expectancy by three years in an average person with Type 2 diabetes in the U.S.,” the study said. “For individuals with very high levels of A1c, systolic blood pressure, LDL cholesterol and BMI, controlling biomarkers can potentially increase life expectancy by more than 10 years.”

Someone, for instance, who is severely obese with a BMI of 41.4 can extend their life 3.9 years if they drop to a BMI of 24.3, the largest increase in life expectancy among the four measures, according to the model. That BMI improvement is the equivalent of someone who stands 5-foot-10 dropping from about 288 pounds down to 160.

Life expectancy is increased 3.8 years for someone with poorly controlled diabetes as reflected by an A1c of 9.9% improving to a normal level of 5.9%.

But people with diabetes can extend their life span even if they don’t hit their optimal treatment goals, Shao said. Generally, more modest improvement also extends life, albeit to a lesser extent.

The study’s authors note that the U.S. health care system is facing a diabetes epidemic. An estimated 37 million Americans have diabetes, about 95% of them Type 2.

Hui Shao, M.D., Ph.D.

“The hope is to show people with Type 2 diabetes in an easily understood way the benefits of controlling their disease,” said study co-author Hui Shao, M.D., Ph.D., an assistant professor in the UF College of Pharmacy’s department of pharmaceutical outcomes and policy and primary developer of the microsimulation on which the research is based. “It’s important to optimize treatment and motivate patients to succeed. Despite improvements in diabetes care and technology, diabetes control is worsening in the U.S. The average A1c is increasing over time.”

The findings were generated by a microsimulation that is optimized using data from a clinical trial involving patients with Type 2 diabetes at increased risk of cardiovascular disease. Called the Building, Relating, Assessing and Validating Outcomes model, or BRAVO, it uses a patient’s risk profile to project long-term health outcomes, including diabetes complications and life expectancy.

Findings show life expectancy is increased by either:

• 1.9, 1.5 or 1.1 years when systolic blood pressure is improved from a high of 160.4 mmHg to 114.1, 128.2 or 139.1 mmHg, respectively.
• 0.9, 0.7 or 0.5 years when LDL cholesterol is improved from a high of 146.2 mg/dL to 59, 84 or 107 md/dL, respectively.
• 3.8, 3.4 or 0.5 years when A1c is improved from a high of 9.9% to 5.9%, 7.7% or 6.8%, respectively.
• 3.9, 2.9 or 2 years when BMI is improved from a high of 41.4 to 24.3, 28.6 or 33.

Even longer life expectancy is possible when the impact of improving multiple biomarkers is combined, hence the finding that someone can bank an extra decade by vastly improving all measures. Shao noted BMI is the most important measure, since losing weight can have a positive effect on the others.

Serena Jingchuan Guo, M.D., Ph.D., and Naykky Singh Ospina, M.D.

“Discussing life expectancy gains as a positive effect of metabolic control can improve conversations about diabetes management by focusing on this important patient outcome,” said Naykky Singh Ospina, M.D., an associate professor in the UF College of Medicine’s division of endocrinology, diabetes and metabolism.

It’s also hoped the work will help tailor treatment to each patient and avoid overtreatment, all the while offering a vivid picture of the benefit of ideal diabetes management.

“Individualizing treatment goals is vital for achieving optimal health outcomes while avoiding overtreatment,” said study co-author Serena Jingchuan Guo, M.D., Ph.D., an assistant professor in the UF College of Pharmacy’s department of pharmaceutical outcomes and policy. “By measuring the potential health benefits for treatment, we hope this helps improve diabetes care in the United States.”

Other study co-authors include researchers at Tulane University, Imperial College London, the University of Pittsburgh School of Medicine and the Centers for Disease Control and Prevention.