Wednesday, February 06, 2008

"Normal" sugars may harm diabetics


I can't even imagine having diabetes. Every day, I talk with and take care of patients with diabetes. I'm just fascinated with the technology out there to monitor blood sugars and to deliver insulin. No longer are just the syringe and the needle. There are stuff like pre-filled insulin pens and even insulin pumps that can deliver the medicine now.

In diabetes treatment, the current thinking has always been to push your average sugar level to a lower and lower number. Now, I'm not talking about too low - like hypoglycemia - but a lower Hemoglobin AIC level (the three month blood sugar level).

In what can be characterized as a stunning move, a federal government study had to be stopped because of deaths NOT due to HIGH blood sugar levels - but because of possible too LOW blood sugar levels (Associated Press)
The government abruptly halted aggressive treatment in a major study of diabetes and heart disease after a surprising number of deaths among patients who pushed their blood sugar to super-lows — findings that call into question a growing movement in diabetes care.
The study was stopped a year and a half early because they found 257 deaths in the group of patients whose blood sugars were aggressively treated. In the article, aggressive treatment meant trying to bring the long range sugar number - the HbAIC - back to a normal range (meaning to the level of a non-diabetic). The other group who were treated with more standard care treatments using current diabetic HbAIC guidelines, only had 203 deaths. Why is this? At this point, researchers are unsure.
The findings contradict previous research suggesting that the lower diabetics can make their blood sugar, the better. That had specialists cautioning Wednesday that it's too soon to know if the finding among heart patients was a fluke, or a real sign of how exquisitely tailored to each patient's risk factors diabetes care must be.
The article goes on to say that as if this point, current treatment guidelines should not be changed until further study is completed. This definitely brings up the question: How aggressive is too aggressive when it comes to treatment of blood sugars in diabetes?

4 comments:

Eric, AKA The Pragmatic Caregiver said...

But weren't the protocols using Avandia to get to those targets?

Dr. A said...

Eric - That's a good point. I admit that I haven't read the study in detail. I'll have to check that out.

Anonymous said...

don't forget that the best evidence to date on pushing A1C down with meds/insulin (ukpds) showed essentially no benefit to tight control in type II DM. This is consitently ignored by most people for some bizarre reason. These early ACCORD studies are completely consistent with what UKPDS already has shown.

MY OWN WOMAN... said...

I'm going to limit myself to comments concerning Type I diabetes. There are times, (and there is a specific name for this syndrome and I can't for the life of me remember it: Somygi Effect?), that a diabetic's blood sugar drops during the night without the patient being aware. Since the Hgb A1C is a 3 month average, these dangerous lows are also filtered into the calculations. I wonder if that has something to do with the deaths and the lower Hgb A1C's. Just a thought.