Cohort studycited by the Tayebat archiveabstract only checked A-INS-09 standard review

Long-term sugar level and survival in type 2 diabetes

Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study.

Overview

Currie CJ et al.. Lancet 2010 · PMID 20110121 · DOI 10.1016/S0140-6736(09)61969-3

Both very low (6.4%) and very high (10.5%) HbA1c were linked to more deaths; lowest risk around 7.5%.

Does the study support the specific claim? Partly · Methodological quality: low

Study explained simply

What did the researchers want to find out?: Survival as a function of HbA1c
How was the study done?: Retrospective cohort (GPRD)
How many people, animals or samples were studied?: 47,970 (27,965 + 20,005); Type 2 diabetes >=50 years intensified to combination orals or insulin
What was actually found?: U-shaped mortality curve.
How large was the observed effect?: HR 1.52 low; 1.79 high
What do the results mean in everyday life?: Moderate control is associated with best survival; high sugar is also harmful.
What are the study's limitations?: Observational; Confounding by indication; Industry funding
What does it say about Elawady's specific claim?: Supports C-INS-04 (U-shape) and mixed for C-INS-05; also contradicts C-DIAB-01 (high HbA1c 10.5% HR 1.79).
Do the results apply to Germany and Europe?: UK data.
What can explicitly not be concluded from this study?: Causality.

Authors: Currie CJ, Peters JR, Tynan A, Evans M, Heine RJ, Bracco OL, Zagar T, Poole CD
Journal: Lancet
Year: 2010
Identifier: PMID 20110121 DOI 10.1016/S0140-6736(09)61969-3
Verification: verified – PubMed E-utilities efetch, 2026-10-25
Retracted: no
Corrections: none
Extent checked: abstract only
Conflicts of interest and funding: Funded by Eli Lilly and Company (insulin manufacturer).

Survival as a function of HbA1c

Study design: Cohort study – Retrospective cohort (GPRD)
Population: Type 2 diabetes >=50 years intensified to combination orals or insulin
Country: UK
Period: 1986-2008
Sample size: 47,970 (27,965 + 20,005)
Inclusion and exclusion criteria: As described in the abstract; details not available in abstract.

Results: U-shaped: lowest decile (6.4%) HR 1.52 (1.32-1.76); highest (10.5%) HR 1.79 (1.56-2.06); nadir about 7.5%. Insulin-based vs combination oral HR 1.49 (1.39-1.59).
Absolute risks: not reported
Authors' conclusion: Low and high HbA1c associated with mortality; guidelines might need a minimum HbA1c.

U-shape association.

Supports C-INS-04 (U-shape) and mixed for C-INS-05; also contradicts C-DIAB-01 (high HbA1c 10.5% HR 1.79).

RCTs.

UK data.

Consistent with avoiding both very low and very high HbA1c.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	low
Risk of bias	high
Precision of results	high
Directness	direct
Reproducibility	partly replicated
Consistency with the overall evidence	consistent
Regional transferability	high
Adequacy of the interpretation (by the archive)	essentially correct but incomplete

None beyond those stated.

Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.

What the archive says about the study: Listed in the archive bibliography for 'insulin-injections' without its own interpretation; used as general support for the claim that insulin intensification harms.
A. What was actually studied?: Survival as a function of HbA1c
B. What did the authors find?: U-shaped mortality curve.
C. What conclusions do the authors themselves draw?: Low and high HbA1c associated with mortality; guidelines might need a minimum HbA1c.
D. What does the archive derive from it?: Supports moderate targets and insulin-associated mortality.
E. Is this derivation scientifically justified?: Justified for moderate targets (consistent with ACCORD); insulin association confounded.
Adequacy of the interpretation (by the archive): essentially correct but incomplete