Posted on 12/17/2008 11:47:25 PM PST by FocusNexus
(HealthDay News) -- Intensive lowering of blood sugar in people with poorly controlled type 2 diabetes does not have a significant effect on reducing cardiovascular events, such as heart attack and stroke, a new study finds.
"You can decrease cardiovascular events in patients with type 2 diabetes by good treatment of lipids [cholesterol], blood pressure and other cardiovascular risk factors," noted lead researcher Dr. William Duckworth, from the Phoenix Veterans Affairs Health Care Center in Arizona. "But among older patients whose risk factors are controlled, intensive glucose control does not add any significant benefit," he said.
The report was published in the Dec. 17 online edition of the New England Journal of Medicine.
The value of intensive blood sugar control has become a highly debated topic, especially since two recent studies looking at the benefits of aggressively lowering blood sugar in people with type 2 diabetes came to different conclusions.
One study, the ADVANCE (Action in Diabetes and Vascular Disease) trial found a 21 percent reduced risk for kidney disease in patients on tight glucose control. On the other hand, the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial found a 22 percent increased risk of death for those on the stricter regimen.
(Excerpt) Read more at washingtonpost.com ...
Ping — I think you have a health and/or diabetes ping list.
Related article:
Intensive Glycemic Control Fails to Prevent Most Microvascular Complications
http://www.medpagetoday.com/Endocrinology/Diabetes/12210
Keeping a tight rein on blood glucose in type 2 diabetes patients did nothing to prevent retinopathy, nephropathy, or neuropathy in the closely watched VA Diabetes Trial, researchers here said.
With a median of 5.6 years of follow-up, rates of microvascular complications did not differ significantly between diabetic veterans who received standard care and those randomized to a regimen of tight glycemic control, reported William Duckworth, M.D., of the Phoenix VA Health Care Center and colleagues online in the New England Journal of Medicine.
Median levels of glycated hemoglobin reached in the trial were 8.4% with standard therapy and 6.9% in the intensive treatment group.
As Dr. Duckworth had reported at the American Diabetes Association meeting earlier this year, cardiovascular outcomes also did not differ between the groups. (See: ADA: VA Diabetes Trial Appears to Vindicate Rosiglitazone (Avandia) Safety)
“Overall, the benefit of decreasing the glycated hemoglobin level from 8.4% to 6.9% appeared to be minimal,” the researchers said in their NEJM report.
“.....intensive glucose control does not add any significant benefit,” he said.”
So as I understand this, I have been denying myself apple pie for nothing.
It's a FReebie that you may have to register - not subscribe - to read the whole article. I only read the abstract so far, but it looks like one more feather in the cap of carbohydrate restriction and exercise as opposed to medical therapy/medicine.
FReepmail me if you want on or off the diabetes ping list.
“So as I understand this, I have been denying myself apple pie for nothing”
Me too!
After this she began to scream horribly. She cursed the poison, railed at it, and implored it to be quick, and thrust away with her stiffened arms everything that Charles, in more agony than herself, tried to make her drink. He stood up, his handkerchief to his lips, with a rattling sound in his throat, weeping, and choked by sobs that shook his whole body. Félicité was running hither and thither in the room. Homais, motionless, uttered great sighs; and Monsieur Canivet, always retaining his self-command, nevertheless began to feel uneasy.
"The devil! yet she has been purged, and from the moment that the cause ceases -- "
"The effect must cease," said Homais, "that is evident."
But what about kidney failure?
I’m about to go on both high blood pressure and T2 diabetes medication.I loath taking pills,even aspirin.
So this sounds good to me.
Oh boy! Now I can have donuts!
/sarc
One huge benefit to glycemic control and lipid control is weight loss. Maybe statisticly there is little benefit but there seems to be individually...at least for me.
My husband has had Type 2 for over 10 years now, and when he was diagnosed, we all went on the Atkins type diet. Hubby has never had to increase his meds, and consistently keeps his blood sugar between 85-110 no matter what he eats. His doctor is sometimes incredulous that after all these years, he has developed no complications from the disease. His comment to my hubby is always, "Whatever you're doing, keep doing it!"
ping
IOW, Atkins was right all along.
That is correct.
Nice testimony, thanks!
Medicine is just a way station along the route to the hereditary inevitability.
Intensive glucose control does not add any significant benefit,
There was recently a study which had to be halted because some of diabetics participating in it were dying. It turns out that tight control may not be the best thing for diabetics. See: http://www.sciencedaily.com/releases/2008/02/080206105440.htm.
Things were basically ok for me until menopause. Since then, I have been battling. I did the low carb thing for almost a year. I thought I was going to go crazy with the restrictions and after 9 months or so, I wasn’t seeing the benefits that I had at first. On top of that, I ended up taking all kinds of other meds for my ‘protection.’
I’ve been doing low fat vegan for almost a year now and am very pleased. No cholesterol meds, no BP meds. My endo took me off of insulin while keeping the metformin. Based on the negative experiences (like death) of some diabetic family and friends this past year, I decided to forgo the metformin w/its liver issues, and stay w/the insulin as needed. At one point a few years ago I was taking 190 units a day. Now I take about 10 units, and don’t have to do that everyday. I also take Byetta, which is a hormone, not insulin, and seems to help me quite a bit. I’m hoping that in another 6 months or so, I will have lost enough weight where I won’t have to take that, either. Oh yeah, no matter what I did previously, I didn’t lose weight. After going vegan, I’m losing weight easily.
This is such an individual disease. I don’t knock Atkins, tho I do think you have to watch your fats. Dr. Bernstein has a similar carb-restricted program that isn’t so fat loaded.
So many of the diabetic treatments seem to do harm - either the meds make you fat or cause liver damage or cause heart attacks. It’s hard for people to make dietary changes, whether it’s vegan or Atkins, but in the end, it seems so much better to care for diabetes w/food choices than meds. Just my 2 cents.
Thank you for taking the time to put that together.
I am new to this diabetic junk. I have already had heart surgery and a stroke (MRSA and a few other things) during the surgery.
A few months ago I learn that I am type 2. My BG was at 400. It’s now down to around 100 =or- at fasting. I do feel better and thanks to my new dog, I have lost over 30 pounds. My feet are still troublesome, but they have also improved.
I have, for the most part, managed to stay within the diet guidance that the diabetic nurses taught during a several week class. I will look at what you have mentioned and discuss it with my doctor. It would be very tough for me to give up meat though.... I am not sure it would even be possible. I recently turned 60, so it seems that there won’t be all that many more years to even worry about this.
Again, thank you.
<I recently turned 60, so it seems that there won’t be all that many more years to even worry about this.
Nonsense. My mother is 78, diabetic for probably 20+ years and doing well. My uncle died several years ago after amputations, severe infections, etc. He never took his diabetes seriously. My father died from a heart attack brought about my uncontrolled diabetes. Most diabetics die from heart-related issues, not the blood sugar levels.
I’m 55. I’d like to hit 100. I can’t do it if my diabetes isn’t in control. I thought I couldn’t give up meat and cheese as well. I looked at the research on veganism & diabetes for years and thought I just couldn’t do it. Well, one day I said, ok, this is it and I haven’t looked back. The lack of cholesterol and the increased fiber in a vegan diet helps tremendously with the heart issues, so that they become a non-issue for vegan diabetics. This is important to me, tho maybe not so much to others. I way more aware of this at 55 than I might be if I were a 30 yr old diabetic.
Keep reading and learning on your own. Learn from other diabetics as well as your health care providers. I’ll send you some Freepermail with more info.
<I recently turned 60, so it seems that there won’t be all that many more years to even worry about this.
Nonsense. My mother is 78, diabetic for probably 20+ years and doing well. My uncle died several years ago after amputations, severe infections, etc. He never took his diabetes seriously. My father died from a heart attack brought about my uncontrolled diabetes. Most diabetics die from heart-related issues, not the blood sugar levels.
I’m 55. I’d like to hit 100. I can’t do it if my diabetes isn’t in control. I thought I couldn’t give up meat and cheese as well. I looked at the research on veganism & diabetes for years and thought I just couldn’t do it. Well, one day I said, ok, this is it and I haven’t looked back. The lack of cholesterol and the increased fiber in a vegan diet helps tremendously with the heart issues, so that they become a non-issue for vegan diabetics. This is important to me, tho maybe not so much to others. I way more aware of this at 55 than I might be if I were a 30 yr old diabetic.
Keep reading and learning on your own. Learn from other diabetics as well as your health care providers. I’ll send you some Freepermail with more info.
Thanks again.
.....so it seems that there won’t be all that many more years to even worry about this......
If you are 60, it might be at least 20
“But what about kidney failure?”
See post 3 for more detail and original link:
“Keeping a tight rein on blood glucose in type 2 diabetes patients did nothing to prevent retinopathy, nephropathy, or neuropathy in the closely watched VA Diabetes Trial, researchers here said.
With a median of 5.6 years of follow-up, rates of microvascular complications did not differ significantly between diabetic veterans who received standard care and those randomized to a regimen of tight glycemic control, reported William Duckworth, M.D., of the Phoenix VA Health Care Center and colleagues online in the New England Journal of Medicine.
Median levels of glycated hemoglobin reached in the trial were 8.4% with standard therapy and 6.9% in the intensive treatment group.”
This is not to say that people should ignore the guidelines, but it seems the numbers are not as cut and dried as endocrynologists are trying to make their patients believe.
My family history predicts to the contrary, but that would be nice, yet we just never know.
Just saw this article:
Vitamin B1 Could Reverse Early-stage Kidney Disease In Diabetes Patients
http://www.sciencedaily.com/releases/2008/12/081208092149.htm
Researchers at the University of Warwick have discovered high doses of thiamine - vitamin B1 - can reverse the onset of early diabetic kidney disease.
Kidney disease, or diabetic nephropathy, develops progressively in patients with type 2 diabetes. Early development of kidney disease is assessed by a high excretion rate of the protein albumin from the body in the urine, known as microalbuminuria.
The research is led by Dr Naila Rabbani and Professor Paul J Thornalley at Warwick Medical School, University of Warwick, in collaboration with researchers at the University of Punjab and Sheik Zaid Hospital, Lahore, Pakistan.
The team has discovered taking high oral doses of thiamine can dramatically decrease the excretion of albumin and reverse early stage kidney disease in type 2 diabetes patients.
In a paper published online in the journal Diabetologia, the team show 300 mg of thiamine taken orally each day for three months reduced the rate of albumin excretion in type 2 diabetes patients. The albumin excretion rate was decreased by 41% from the value at the start of the study. The results also showed 35% of patients with microalbuminuria saw a return to normal urinary albumin excretion after being treated with thiamine.
Yeah, great for most, but at 5'10 150lb I'm just trying not to blow away.
I advised him to worry about what to do when he was 85. He is now 88 but suffers from Alsheimers. What he worried about at that lunch was never a problem.
I've been prescribed Metformin but it requires NO alcohol—and I do enjoy a Bud now and again.
If the info of this article is correct and I watch my carb intake along with B1 supplements and regular exercise,I may be able to forgo the pills.
Of course I'm not rushing into anything—it will require more research—but I hate to completely divorce my buddy Bud.
Wish I had that proble,...I plateau and stay there or gain...
Frustrating as all get out.
Lifestyle changes have dramatic effect though. Did anyone see the recent Biggest Loser finale? They had the sickest man, in his 50s but looked 100, on there, and he had every kind of health problem, was taking every kind of pill. At the finale, he got a Standing O for losing the weight (he was not one of the winners at all) and working out and eating right: the Century City doc came on and was wiping away tears at the amazing turnaround at the man’s medical testing. He’s fit and healthy today, no meds. He’s a cop, too.
“Of course I’m not rushing into anything—it will require more research—but I hate to completely divorce my buddy Bud.”
Read, do your own research, and talk to your doctor, etc., don’t make any decisions or take any significant actions based on one article, or advice from anonymous posters, etc. — HOWEVER, I would like to add some additional things that you might want to research further and possibly experiment with, by checking your blood sugar often.
As far as I read and heard, the main reason they don’t want diabetics to drink alcohol, especially when they are on medication, is because ALCOHOL LOWERS blodd sugar, and they are concerned that when people drink alcohol, they drop their blood sugar too much, which is one of the dangers of taking medications. I read that when you drink alcohol, your liver stops making glucose, until it metabolizes alcohol.
I do not recommend that you drink, but if I were you, before going on medication, I would recommend trying the diet and exercise routine and maybe that occasional beer you like, preferably in the evening, not during the day. I would suggest very close monitoring of your blood sugar of several times a day, including before the drink, an hour afterwards, then again a little later,and so on, so you can find out yourself the impact it has on your blood sugar.
If you do go on medication, do read up on the medication itself and whether it interacts with alcohol or vice versa.
Another thing I recommend reading up on is resveratrol and garlic, as well as herbs.
Here are some websites that you might want to start with — remember, I am not recommending any products, just research, so you can find out and decide for yourself.
Resveratrol:
http://www.diabetesinfocenter.org/View.aspx?url=Diabetes_Resveratrol
http://ajpendo.physiology.org/cgi/content/full/290/6/E1339
Garlic:
http://www.sciencedaily.com/releases/2008/11/081119084835.htm
Herbs — Check out the ingredients individually also:
http://www.flourishwellness.com/store/comersus_viewItem.asp?idProduct=63
The problem is they are treating the numbers and not the underlying problem, which in type 2 diabetics is the excess insulin being released and the burn out of beta cells.
I know this is not cheery news, but perhaps the only way to fight this disease is to go on a very low carb diet. And, for all the researchers know, that may not do it, but it seems to be the best hope.
Doctors and researchers need to stop obsessing about BG and A1C numbers. Everybody is being lulled into a false sense of security because they see their numbers lowered by medications. All they get out of it, though, is lower numbers.
http://www.mendosa.com/lowcarb.htm
http://abcnews.go.com/Health/Story?id=3232247&page=1
And if you can find a way to access it without paying to read it, “Oral Hypoglycemics and Diabetic Nephropathy” by Nortin M. Hadler in the Clinical Journal of American Nephrology 2: 159-162, 2008
Ping
ping for later read.
Thank you, thank you very much. ( that was my impersonation of Elvis..LOL)
Presently I keep my carbs down to 3 carb servings per meal (15 carbs per serving) I try to have two mid meal snacks a day keeping then to no more than 1 carb. I was told not to count sugar and instead count the carbs.
Exercise seems to be critical in keeping the BG down. My GSD pup makes sure I get exercise. For now, I can keep my BG down to about 100 at fasting. It does go up during the day but generally no more than in the 120’s. When I was first diagnosed with this junk, my BG was 400. I also take 70 units of insulin each night and metformin once a day.
Having said all of that, here is my attitude. There is no way of getting out of this life without dying. I love most things in my life and at 60, I don’t at all feel cheated. I figure that as long as God wants me here, I get to continue with this wonderful gift of life. When I was about to go into heart surgery I told my Bride, of over 36 years, that I just wanted my fishing gear ready and my soul ready, that way I figure I had everything covered regardless of how things came out. Well, I later went fishing ; >)
Anyway, thank you very much.... and Merry Christmas.
No, you have been watching your weight. I also believe that someone with just one kidney should watch their sugar intake.
You have a great attitude. :-)
What is a GSD? We have a GSP (German Shorthaired Pointer). He’s crazy, but we love him dearly.
Me too!
Gator113, have you been denying askrenr apple pie?
“What is a GSD?”
A German Shepherd Dog named Falco.
Here’s my 6 month old boy...
http://i240.photobucket.com/albums/ff195/Gator113/IMG_0800.jpg
http://i240.photobucket.com/albums/ff195/Gator113/IMG_0793.jpg
http://i240.photobucket.com/albums/ff195/Gator113/Falcosnowjump1001.jpg
http://i240.photobucket.com/albums/ff195/Gator113/Falcosnowball.jpg
What a beautiful dog! Thanks for sharing your pictures.
Here is some helpful information on Blood Sugar and the ravages of glycation, particularly in the context of aging:
http://www.terraternal.com/CategoryAbout.aspx?cid=14
The news story opening this thread finds that:
“older patients whose risk factors are controlled, intensive glucose control does not add any significant benefit,” he said.”
This seems to me to be missing the point. In older patients who have Diabetes, glycation, which is the ultimate cause of so many of the symptoms of Diabetes, has run its course already. Glycation is irreversible, and so it should not be surprising that lowering blood sugar late in life does not reduce the cardiovascular risk associated with Diabetes. But in the effort to prevent glycation, low blood sugar is everything.
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