From the Guidelines
People with well-controlled diabetes mellitus (DM) can expect to live nearly as long as those without diabetes, with only a modest reduction in life expectancy of about 3-5 years on average, as long as they maintain good glycemic control, typically with hemoglobin A1C levels between 7% and 8% 1. To achieve this, a combination of lifestyle modifications and medications is usually necessary. For type 2 diabetes, first-line therapy often includes metformin, along with a diet rich in vegetables, lean proteins, and complex carbohydrates, regular physical activity, and weight management.
- Key aspects of management include:
- Maintaining hemoglobin A1C levels between 7% and 8% to minimize the risk of microvascular and macrovascular complications 1.
- Regular monitoring of blood glucose, with adjustments to therapy as needed to maintain target levels.
- Annual eye and foot exams to detect early signs of complications.
- Kidney function tests to monitor for signs of nephropathy.
- Cardiovascular risk assessment and management, including blood pressure control (target <140/90 mmHg) and cholesterol management.
- Avoiding smoking, as vascular complications are the primary cause of reduced lifespan in people with diabetes. It's also important to consider individualizing HbA1c targets based on patient characteristics, such as comorbid conditions, risk for hypoglycemia, and life expectancy, as outlined in the guidance statements from the American College of Physicians 1.
- For example, patients with a life expectancy less than 10 years, or those with advanced age (80 years or older), residence in a nursing home, or chronic conditions such as dementia, cancer, end-stage kidney disease, or severe chronic obstructive pulmonary disease or congestive heart failure, may benefit from less stringent HbA1c targets, focusing instead on minimizing symptoms related to hyperglycemia 1. By prioritizing these aspects of care, individuals with well-controlled diabetes can maximize their life expectancy and reduce the risk of complications.
From the Research
Well-Controlled Diabetes and Life Expectancy
There are no direct research papers to assist in answering this question. However, some studies provide information on the relationship between well-controlled diabetes and various health outcomes.
- A study published in 2021 2 found that the use of continuous glucose monitoring (CGM) was associated with improvements in psychosocial outcomes and improved HbA1c levels for people with type 1 or type 2 diabetes who use intensive insulin therapy.
- Another study published in 2020 3 found that patients with type 1 or type 2 diabetes could achieve a mean HbA1c reduction of 0.70-0.96 percentage points with insulin degludec compared to insulin glargine 100 units/mL, before incurring an equivalent risk of hypoglycaemia.
- A study published in 2010 4 compared the dosing and impact of two basal insulin analogs, insulin glargine and insulin detemir, on weight and hemoglobin A1c (A1c) in individuals with type 2 diabetes mellitus.
- A review published in 2018 5 discussed the role of HbA1c in the diagnosis of diabetes and the controversies surrounding its use as a diagnostic criterion.
- However, a study published in 1979 6 is not relevant to the topic of well-controlled diabetes and life expectancy, as it discusses the antihistamine properties of tricyclic antidepressants.