Take all articles you read with a grain of salt

For example:
Exercise, diet better than medicine for treating Type 2 diabetes, says UBC group

I read a lot about diabetes. And hopefully know enough not to pay attention or take too seriously some articles.

I learnt from very early on that, what I like to call the triangular method of treatment: Exercise, Medication and Diet must be employed. All of these then must be observed by checking sugar, weight, blood pressure and your own body regularly. I myself have already daily, monthly, quarterly(blood and urine lab tests) and annual records from 2010. Now if you think what I do is extreme, know that there are a lot of diabetics who record, separate(carbs and protein) and then weigh their food every meal.

This article is way behind the curve. My radar went to full alert when I read

Type 2 diabetes . . . is largely caused by obesity

And I quit reading and walked away after

there’s still no conclusive evidence that taking medications to lower blood glucose levels will decrease complications

Guess the DCCT and related studies were figments of my imagination.

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There are a few bloggers that I do pay attention to
Maybe you have heard of this guy
David Mendosa

This is also where the writer lost my credibility. Poor assumption, poor journalism, lazy writing.

Actually, the data specifically for T2s comes from UKPDS not DCCT. Same outcomes though… Each 1.0% increase in HbA1c leads to an approx. 40% increase in the rate of micro- and macroangiopathies.

Joe

Hey Joe, I just spent a couple of minutes wikiing your statement and can’t understand what you wrote. Can you please explain
thanks Davo

Davo:

The first study to identify a strong link between Glucose levels (specifically HbA1c) and rates of complications, was the DCCT trial which looked at T1s who were either on an intensive insulin/carb counting regime to try to minimize HbA1c or controls (who were not). The outcomes were roughly that the rates of microvascular complications (diseases of small blood vessels leading to eye and kidney problems or peripheral amputations) increase by ~40% for each increase in HbA1c (starting from 7%). This means that with HbA1c= 8% you are 1.4 times more likely to experience these compared to HbA1c=7.%, but with HbA1c = 11% you are 3.8 times (1.4x1.4x1.4x1.4) time more likely to experience any of these complications.

A similar sort of trial, but on a substantially larger scale was carried out in the United Kingdom (UKPDS) only this time the subjects were T2. The results showed a near identical effect of increased HbA1c on the risk of these complications and a similar rate of increase risks of cardiovascular complications (aka macroangiopathies) .

Hope this explains

Joel

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Thanks Joel,
I already sort of understood that - just without the %s.
I have another question which is slightly related which you might know the answer.
What you explained to me is the relationship between HbA1c and health complications. Do you know about the relationship between HbA1c and a blood sugar reading. I’ll elaborate.
I have a quarterly HbA1c blood test. I’ve been doing this for 8 years because I learnt very early on it gives an average of my blood sugar reading for the past 3 months.

  1. I have since read (from an article that I can no longer find) that it the HbA1c reading does not give an overall average. that is to say that if I had for the first 2 months I had good blood sugar readings and only in the 3rd month I had higher than good readings then the 3rd month would have an added effect on my HbA1c result. ie; not giving and straight average of the 3 months.

  2. Do you know the effects of 1 high carbohydrate meal giving you and elevated blood sugar reading for several hours on your HbA1c?
    I ask this because there are occasions that I (and I’m sure many other diabetics) have indulged.
    Now I have had a doctor who asked me to measure my blood sugar ~ 2 hours after the meal.
    My results have been wide ranged from 80 mg/dL - 300 mg/dL.
    (For some reason sometimes my blood sugar goes down after I eat fish - sometimes below 50)
    So anyway if I have a blood sugar reading for the 2 hours before I take the reading and then say it will take another 2 hours to bring it down (either by medication or other means). That means I have had elevated blood sugar for 4 hours. What effect does that single event have on my HbA1c within the 3 month cycle(saying that this was my only indiscretion during the 3 months)? And if it did not significantly change my HbA1c, does it have any effect on my health. ie microvascular complications.

thanks Davo
ps. I’ve been trying for a couple of years to communicate these questions - so thanks again

UKPDS = United Kingdom Prospective Diabetes Study.

Thanks Terry,
Very interesting stuff - now tell me if I’m wrong from what I got out of the article…
That from tests taken more than a 1/4 of a century ago, Neither insulin or oral medication lessened the risk of a diabetic having a heart attack but it did improve slightly the risk of complications of the microvascular kind.

HbA1c is related to the average Blood Glucose levels over approximately the three month period prior to the test. The HbA1c level is weighted so that BG levels in the past month influence HbA1c more than those of three months ago. Transient spikes in BG (e.g. after a meal) will tend to raise your average BG and hypos will reduce it and these will have an effect on HbA1c. There are websites that allow you to calculate Average BG from HbA1c. However, these are approximations only and there are individual differences which mean that for some people the HbA1c give a closer indication of the true Average BG than for others.

http://www.diabetes.co.uk/hba1c-units-converter.html

Joel

I like to describe the value of the A1C like this. Let’s say, for simplicity’s sake, that the goal is 5. If your Bg’s masciaslly 5, 5, and 5 then your A1C is 5. But if your bg’s are 1, 5 and 10 then basically, your A1c is still 5.

Thanks Artwoman. And that brings me back to my question whether the overall health of “5,5 and 5” and “1,5 and 10” are the same or not