[acb-diabetics] tight control may not be so imp9portant for type 2 diabetics with other health issues

[Patricia LaFrance-Wolf]

Study Finds Tight Blood Sugar Control not so Important if Other Medical
Problems are Present 

Patrick Totty

Jan 13, 2010 

 

A five-year study of 2,613 people treated for diabetes at Italian clinics
shows that tight 

blood sugar

 control may not be the number-one priority for patients who have other
medical problems. 

 

The study, which was published in the December 15, 2009 issue of the Annals
of Internal Medicine, was led by Dr. Sheldon Greenfield, a professor of
medicine

at the University of California at Irvine. Dr. Greenfield set out to
determine how much of a reduction in cardiovascular problems was gained by
patients

with diabetes who achieved 

A1c

 levels of 6.5% or below. (The American Diabetic Association recommends 7%
as the goal that most people with 

type 2 diabetes

 should aim for). He found that lower A1c's worked best to reduce heart
risks in people who had few medical problems besides their diabetes. But for
people

with other medical problems, such as high blood pressure, high 

cholesterol

, and foot or gastrointestinal ailments, lower blood glucose levels did
significantly lower their risk of cardiovascular events such as stroke or
heart

attack.

 

Greenfield and his associates concluded that people who have diabetes and
other medical problems may want to focus more on the treatment of those
other

problems and not make tight blood sugar control their first priority. In a
recent HealthDay article, Greenfield is quoted as saying an A1c level
between

7% and 8% for 

type 2

 patients who have significant other medical problems is a reasonable goal. 

 

Dr. Greenfield's study comes in the wake of other studies, such as the
ACCORD study that was suspended in 2008, which showed that very tight blood
glucose

control actually increased the risks of cardiovascular events-the opposite
of what researchers expected. In the ACCORD study, more than 10,000
Americans

with type 2 diabetes were tracked to see the effects of tight blood glucose
control on the risk of cardiovascular disease. In many cases, patients
reached

A1c's as low as 6%. However, researchers began noting a statistically
significant increase in the number of tight-control patients who experienced
or died

from cardiovascular problems, and they called off the study.

 

At the same time, a larger European-based international study very similar
to ACCORD showed no statistically significant increase in cardiovascular
risks

among tightly controlled type 2s. So there is still an ambiguity about the
benefits of tight control. Greenfield's study shows that the presence of
other

medical problems may have been a factor in the ACCORD findings because the
emphasis on tight control may have distracted attention from other medical
problems.

 

* * *

 

Source:

 

http://www.nlm.nih.gov/medlineplus/news/fullstory_93021.html

 

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