More on Insulin vs Lifespan-: was- Re: New Here

[Guest guest]

> Please consider the study reported at <

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16368297&query_hl=1&it

ool=pubmed_docsum

OK, but that was " all-causes " mortality, not just mortality from

heart attack within 12 months. That could presumably have included

those who got themselves run over by a truck or who fell out of a

tree.

Most people who have been on this list for some time would not be

surprised by that result. We were always agreed that it is better to

get off oral medication by diet and exercise, or at least reduce the

dose, if it is at all possible without sacrificing too much HbA1c

(it is a trade-off) and we have always said that we all have to go

sooner or later but we would prefer to go naturally rather than with

a batch of complications. We cannot expect that to be without some

kind of trade-off. Some time back I did mention a report of a 92-

year-old man in Germany who had had diabetes for over 50 years and

had doctor's written confirmation that he had had every diabetes

complication known to medical science and was still going strong. He

was objecting to the doctor's attempt to alter his self-determined

insulin dose to improve his BG control!

> On the other hand, please also consider the study reported at

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15616228&query_hl=4&it

ool=pubmed_docsum>

> or <*http://tinyurl.com/c96dr*

>. This second study concludes, with and

> againt the results cited by , that " the severity of

> diabetes or the preclinical duration of diabetes and the

> need for drug therapy, and not the therapy itself, is an

> explanation for heart failure in patients with type 2

> diabetes. "

Yes, but that report says that it was concerned with heart failure

in DM2 patients on oral medication in the first year after diagnosis

and that the effect was not found after the first year. I deduce

from that: On oral medication, if you survive the first 12 months

after diagnosis, you are over the point at which your chances of

survival from a serious cardiac event are adversely affected by the

length of time before you were diagnosed or by the severity of your

diabetes.

The two reports still do not alter my opinion that the blood

pressure tester and the periodic stress EKGs and the regular cardiac

exercise to make sure that the results are good are just as

important to a diabetic as the HbA1c measurements. Not more

important but just as important.

The moral is that diabetes is by far not the worst thing that can

happen to you and while you are working on your diabetes you might

just as well pay close attention to all other aspects of health care

from which you could benefit and the heart must surely be the first

candidate for attention.

Regards

[Guest guest]

Hi and all,

> OK, but that was " all-causes " mortality, not just mortality from

> heart attack within 12 months. That could presumably have included

> those who got themselves run over by a truck or who fell out of a

> tree.

>

Hmm, I don't see a substantial problem with using all-causes mortality as

the outcome variable. Do you suggest that patients having A1C 7.0 or less

are more likely to get run over by a truck or fall out of a tree ? Other

things being equal, I'd expect these risks to be higher for the *more*

hyperglycemic group. So, using this (admittedly less than perfectly precise)

outcome variable would seem to me to lead to an understated, rather than

overstated, result of the sort actually obtained.

We were always agreed that it is better to

> get off oral medication by diet and exercise, or at least reduce the

> dose, if it is at all possible without sacrificing too much HbA1c....

>

Please note that the two patient groups were similar in " insulin, metformin,

and glitazone use. " So, we don't seem to be able to point to the method of

glycemic control as a factor explaining the result.

As odd as the result may be, there seems to be *something* going on. I wish

the full-text article were available....

Most people who have been on this list for some time would not be

>

surprised by that result.

>

I must misunderstand your statement that the study results were

unsurprising. You're saying that the notion that low A1C is more dangerous

(among patients studied) than high A1C makes sense to you? Even the study's

authors had trouble interpreting that result .

In any case, please bear in mind my statement that the results of any single

study don't mean all that much. In that context, I think that we agree on

more than we disagree. But, when a study's results are as odd as these,

they're hard to entirely ignore, even if they're all but impossible to

reliably interpret.

Cheers,

[Guest guest]

Hi and all,

> OK, but that was " all-causes " mortality, not just mortality from

> heart attack within 12 months. That could presumably have included

> those who got themselves run over by a truck or who fell out of a

> tree.

>

Hmm, I don't see a substantial problem with using all-causes mortality as

the outcome variable. Do you suggest that patients having A1C 7.0 or less

are more likely to get run over by a truck or fall out of a tree ? Other

things being equal, I'd expect these risks to be higher for the *more*

hyperglycemic group. So, using this (admittedly less than perfectly precise)

outcome variable would seem to me to lead to an understated, rather than

overstated, result of the sort actually obtained.

We were always agreed that it is better to

> get off oral medication by diet and exercise, or at least reduce the

> dose, if it is at all possible without sacrificing too much HbA1c....

>

Please note that the two patient groups were similar in " insulin, metformin,

and glitazone use. " So, we don't seem to be able to point to the method of

glycemic control as a factor explaining the result.

As odd as the result may be, there seems to be *something* going on. I wish

the full-text article were available....

Most people who have been on this list for some time would not be

>

surprised by that result.

>

I must misunderstand your statement that the study results were

unsurprising. You're saying that the notion that low A1C is more dangerous

(among patients studied) than high A1C makes sense to you? Even the study's

authors had trouble interpreting that result .

In any case, please bear in mind my statement that the results of any single

study don't mean all that much. In that context, I think that we agree on

more than we disagree. But, when a study's results are as odd as these,

they're hard to entirely ignore, even if they're all but impossible to

reliably interpret.

Cheers,

[Guest guest]

Hi and all,

> OK, but that was " all-causes " mortality, not just mortality from

> heart attack within 12 months. That could presumably have included

> those who got themselves run over by a truck or who fell out of a

> tree.

>

Hmm, I don't see a substantial problem with using all-causes mortality as

the outcome variable. Do you suggest that patients having A1C 7.0 or less

are more likely to get run over by a truck or fall out of a tree ? Other

things being equal, I'd expect these risks to be higher for the *more*

hyperglycemic group. So, using this (admittedly less than perfectly precise)

outcome variable would seem to me to lead to an understated, rather than

overstated, result of the sort actually obtained.

We were always agreed that it is better to

> get off oral medication by diet and exercise, or at least reduce the

> dose, if it is at all possible without sacrificing too much HbA1c....

>

Please note that the two patient groups were similar in " insulin, metformin,

and glitazone use. " So, we don't seem to be able to point to the method of

glycemic control as a factor explaining the result.

As odd as the result may be, there seems to be *something* going on. I wish

the full-text article were available....

Most people who have been on this list for some time would not be

>

surprised by that result.

>

I must misunderstand your statement that the study results were

unsurprising. You're saying that the notion that low A1C is more dangerous

(among patients studied) than high A1C makes sense to you? Even the study's

authors had trouble interpreting that result .

In any case, please bear in mind my statement that the results of any single

study don't mean all that much. In that context, I think that we agree on

more than we disagree. But, when a study's results are as odd as these,

they're hard to entirely ignore, even if they're all but impossible to

reliably interpret.

Cheers,