tight control may not be so imp9portant for type 2 diabetics with other health issues

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

Problems are Present

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 ls

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