The BIG news of the day is that intensive blood sugar control doesn’t benefit people with both type 2 diabetes and heart disease. In fact, intensive treatment to lower blood sugar is linked to increased mortality, according to a long-running study whose findings were published today.
This reminds me of a discussionthat I participated in a TuDiabetes forum a couple of week ago. The issue being discussed was A1c/eAG levels. I had written: “My diabetologist says that diabetics have higher eAG than normal, healthy individuals. Indeed, he says that it is better for diabetics to have an eAG of ~ 180 than ~ 140. He says in his experience diabetics who try to emulate normal eAG levels suffer more complications - cardio, renal, vascular, optho - than those with slightly higher values. He cites the example of a few patients (now age 80+) who have remained at 200+ for 30 years!”
Clinical trials now seem to have validated anecdotal evidence. The New England Journal of Medicine reported today that according to the latest analysis from the long-running ACCORD study, trying to maintain the blood sugar levels typical of people without diabetes can increase the risk of death for people with type 2 diabetes and heart disease by 19 percent.
ACCORD stands for Action to Control Cardiovascular Risk in Diabetes. This study was designed to assess whether intensive blood sugar interventions to bring A1C levels to under 6 percent would benefit people with type 2 diabetes and heart disease.
A1C is a long-term measure of blood sugar control, and the A1C level provides about two to three months of average blood sugar levels. A level of under 6 percent, which is considered normal or non-diabetic, can be difficult for someone with diabetes to achieve.
This brings me to the outlook of many TuDiabetes members (many of who take their management very seriously). Replying to my response mentioned above, one member wrote: “I disagree with the idea that lower blood sugar levels cause more complications….The largest intervention study to date, the DCCT pretty conclusively found that risks of “all” complications could be decreased by reducing blood sugars. Data from the DCCT conclusively substantiated that down to below 7% (154 mg/dl eAG). Further studies have found additional support that additional risk reductions occur all the way down to A1cs of even 5.5%. The American Association of Clinical Endochrinologists in fact suggests that patients “Encourage patients to achieve glycemic levels as near normal as possible without inducing clinically significant hypoglycemia”.”
Another quipped: “If your diabetologist is implying that averaging 180 is okay (over the Renal Threshold), then he desperately needs to go on a high-fiber diet.”
Fair enough. All of agree that BS levels should be as close to normal as possible. But do we have to adopt an aggressive approach to diabetes management just because the doctors says so? Ground Zero observations have revealed that many diabetics do NOT suffer complications. (See my earlier post on this here.)
It should not be forgotten that aggressive insulin therapy also necessitates the need of continuous monitors, a luxury most diabetics cannot afford (given the high cost of testing strips). In India where I live, only a minuscule number of people test BS on a daily or even weekly basis. The norm is to test fasting and post-prandial levels only when one visits a diabetologist, which is not more than 2-3 times in a year. (My diabetologist says most of his patients turn up only when they’re really sick.)
Of course I’m guilty of poorly paraphrasing my diabetologist’s observations. But essentially he’s right and the recent ACCORD study validates a diabetologist’s long experience of treating a variety of patients in a (clinically) ‘hostile’ environment.
I really appreciate your quoting me. I almost feel useful. I read the paper, I appreciate your pointing me to it. But really it adds nothing to matter, it just rehashes what has already been reported. The ACCORD study was a huge waste. The intensive arm was almost all given Avandia, a drug now basically withdrawn from the market because it “kills people.” The fact that higher mortality was found in the intensive arm is meaningless, you can’t factor out the use of a known deadly drug since everyone used it.
This whole discussion of whether high blood sugars leads to complications and shortened lives has been going on for 100 years. Often studies are done which result in different findings and revealing truth can be difficult. Given the flaws in ACCORD it is very hard to suggest it should be used to overturn opposite results from other studies such as the DCCT. I am glad you like your diabetologist. I think if he were my doctor, I would be referring to him as my “former doctor.”
I think this is Garb…Its strange that so many Doctors come from India to the Us and teach us to keep our Bs under control. I had a Wonderful Dr, actully the Best and I really Loved her and she was From India, she took such good care of me. She was at Kaiser in SD. Boy the loss of her has been sad for me, but the learning from her is what has helped me so much.
I know if you don’t take care of your self, as my Grandmother did, she had type 2, and 10 yrs into it, a Heart Attack and Kidney problems. Yes she live to 88 yrs old, but it was a very sick life she lived.
My X Father in-law had Type 2 and took many med for the Tri O of ills he had, all from Diabetes. He got Hogkins and the Dr all said it came from unmanaged Type 2 Diabetes. He didn’t take care of himself.
I have had Type 1 for 39 yrs, Syringes have been my choice, and my eyes show no sign, and my kidneys are fine, no protien build up. I guess the care of controling my BS numbers for the most part have helped me greatly.
Avandia is Poisen,
First of all this is not news. The study concluded in 2008 and has been widely reported since then. It's popped up in the past few days because some PR person out there has issued some press release and some gullible media have picked up on it.
Jenny of Bloodsugar101 has written a comprehensive rebuttal of this flawed and deeply misleading piece of 'research'.
Jenny's fine summary of what the research actually says is:
'People who attempted to lower their A1c to 6.5% using a combination Avandia, insulin, and a high carb diet had a higher risk of death only when they did not actually achieve a lowered A1c. The people who DID manage to lower their A1cs in the ACCORD "intensive control" group did fine.'
I suggest you share it with your diabetologist too.