Intensive Versus Conventional BG Debate Rages On

Although this study is little different from the other European studies published recently it does add a few insights and hypothesize on some other ideas and for that I will give them credit. However, they leave a few things unstated that need definition. When they use the term conventional, they do nothing to enlighten readers about how the term is being used or meant to indicate.

From some other statements, we are left wondering what they consider normal blood glucose levels. We can all guess when they say normal levels of people without diabetes. So normal levels for people with diabetes is considered ??? (guessing about 7.0 on the US A1c scale).

One thing everyone seems very concerned about in all the articles published recently is hypoglycemia. I do agree that it is something to be concerned about, but unless you are hypoglycemically unaware or afraid to test, I find this argument less than appealing in proper management of diabetes. It is always a factor that needs careful attention and concern, but if a person is careful and understands their body, a blood glucose level of 5.5 to 6.4 A1c is attainable without intensive lowering therapy.

Then when you add exercise and nutritional restraint it is even more attainable and the blood glucose level of 5.0 is reasonable. I will admit that I would be concerned about getting to the level of 4.5 for an A1c and the possibility of hypoglycemia.

The authors state that while there was little difference between intensive and conventional blood glucose therapy, there is a definite advantage for lower blood glucose levels in reducing the small blood vessel damage leading to damage to the eyes and kidneys. They forget to mention the additional advantages of lower blood glucose levels in preventing blood vessel damage to the inner ear to prevent hearing loss and the prevention of diabetic neuropathy.

This study basically covers the same ground as the German and French studies, but it was done in Denmark. I have written about these studies also. The press release for this study can be read here.