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.
Showing posts with label Type 2. Show all posts
Showing posts with label Type 2. Show all posts
03 August 2011
29 July 2011
Another Bad Science Study - Type 2 Diabetes
When are researchers and doctors going to wake up and learn? Apparently never! Another study published in the British Medical Journal (BMJ) warns doctors about placing their Type 2 diabetes patients on intensive glucose lowering treatments. Again they say that most doctors do this believing the patient will have a reduced risk of heart complications.
This time the study was done in France. They did not name this study shamefully so that we had something to refer to like we did in previous studies. Plus no mention was given as to whether this meta study used much of the same data used in other studies - ACCORD and ADVANCE or even the study done by the German group IQWiG, the Foundation for Quality and Efficiency in Health Care. For all we know they could have used the same information.
Again the researchers arrive at the same conclusion that there was no compelling reason to use intensive glucose-lowering treatment, also known as glycemic lowering therapies as are commonly prescribed in order to reduce the diabetes type 2 patient's risk of having cardiovascular complications, as well as renal and/or visual problems.
The researchers found the following benefits were identified with intensive glucose lowering treatments - the risk of non-fatal heart attacks dropped by 15% and the risk of microalbuminuria fell by 10% (an indication of heart disease and kidney problems). However, the treatment was associated with a 100% increase in the risk of dangerously low blood glucose levels (severe hypoglycemia).
The the authors felt it necessary to say - "Intensive glucose lowering treatment of type 2 diabetes should be considered with caution and therapeutic escalation should be limited."
It is not surprising that researchers and doctors repeatedly analyze data looking for information that is not there. Like others have said, bad results are obtained when the incorrect premise is used. In other words, bad science because they were looking for the wrong answers. Like Alan said in his blog (here) and I repeated in my previous blog (here), no consideration was done for changing lifestyle habits of diet and exercise.
If people will not change their lifestyles and are put on intensive glucose-lowering therapies, there is no reason to expect anything other than the results obtained. I say that they should stop spending money on worthless analysis of things that we already know, and concentrate on ways to get the results needed to reduce cardiovascular events and the other complications diabetes can cause. This means looking at what lifestyle changes will accomplish this and how best to work with patients to obtain these results.
This needs to be a lengthy study as it does take time for people to get into an exercise routine that they can sustain and enjoy. Changes in eating habits also take time as people have developed bad habits over time and will have to be shown how to sustain good eating habits and get past the hunger pangs and into good dietary habits. Other lifestyle changes will also be necessary such as regular eating times and carbohydrate counting will become necessary.
Then once these are in full operation and patients are seeing results, then glucose-lowering therapies can be gradually introduced if needed to assist patients in achieving their goals and possible reduce or prevent the related diabetes complications. It should be possible to patients to do lifestyle changes to manage diabetes and lower the risks for complications – if done properly.
The press release of this study may be read here.
This time the study was done in France. They did not name this study shamefully so that we had something to refer to like we did in previous studies. Plus no mention was given as to whether this meta study used much of the same data used in other studies - ACCORD and ADVANCE or even the study done by the German group IQWiG, the Foundation for Quality and Efficiency in Health Care. For all we know they could have used the same information.
Again the researchers arrive at the same conclusion that there was no compelling reason to use intensive glucose-lowering treatment, also known as glycemic lowering therapies as are commonly prescribed in order to reduce the diabetes type 2 patient's risk of having cardiovascular complications, as well as renal and/or visual problems.
The researchers found the following benefits were identified with intensive glucose lowering treatments - the risk of non-fatal heart attacks dropped by 15% and the risk of microalbuminuria fell by 10% (an indication of heart disease and kidney problems). However, the treatment was associated with a 100% increase in the risk of dangerously low blood glucose levels (severe hypoglycemia).
The the authors felt it necessary to say - "Intensive glucose lowering treatment of type 2 diabetes should be considered with caution and therapeutic escalation should be limited."
It is not surprising that researchers and doctors repeatedly analyze data looking for information that is not there. Like others have said, bad results are obtained when the incorrect premise is used. In other words, bad science because they were looking for the wrong answers. Like Alan said in his blog (here) and I repeated in my previous blog (here), no consideration was done for changing lifestyle habits of diet and exercise.
If people will not change their lifestyles and are put on intensive glucose-lowering therapies, there is no reason to expect anything other than the results obtained. I say that they should stop spending money on worthless analysis of things that we already know, and concentrate on ways to get the results needed to reduce cardiovascular events and the other complications diabetes can cause. This means looking at what lifestyle changes will accomplish this and how best to work with patients to obtain these results.
This needs to be a lengthy study as it does take time for people to get into an exercise routine that they can sustain and enjoy. Changes in eating habits also take time as people have developed bad habits over time and will have to be shown how to sustain good eating habits and get past the hunger pangs and into good dietary habits. Other lifestyle changes will also be necessary such as regular eating times and carbohydrate counting will become necessary.
Then once these are in full operation and patients are seeing results, then glucose-lowering therapies can be gradually introduced if needed to assist patients in achieving their goals and possible reduce or prevent the related diabetes complications. It should be possible to patients to do lifestyle changes to manage diabetes and lower the risks for complications – if done properly.
The press release of this study may be read here.
28 July 2011
Should We Strive for Lower BG Levels?
Everyone seems concerned with Type 2 diabetes and the advantages and disadvantages of maintaining near or normal blood glucose levels. What no one is willing to tell us is a way to maintain stable blood glucose levels.
The advantages of maintaining lower blood glucose levels are less risk of heart attacks, kidney failure, neuropathy, and loss of eyesight. The disadvantage generally is listed as one problem and that is hypoglycemia. Generally hypoglycemia is listed as blood glucose readings below 70 mg/dl. I would agree that this should be the lower limit for most people and for some nearer to 80 mg/dl. I admit that I do not get concerned until I get lower than 65 mg/dl, but this is not good for most people.
I will not discuss the study from Germany that has so many flaws in it that it is easy to understand why they take the position they do. When a healthcare system is operated by the government, cost is always at issue and often best results are deemphasized at the harm of the patient. Alan at loraldiabetes does an excellent job of analyzing the study and showing its weaknesses and I urge you to read his blog about this.
I do need to quote Alan here though – Quote The problem (of the study) is not the goals but the methods. Sadly, all they have done is confirm something that has been discussed by type 2 diabetics on diabetes forums ever since ACCORD and ADVANCE (both are included in this meta-study) were published. Those papers did not show that tight control is harmful, instead they showed that intensive use of oral medications and/or insulin to push A1c or FBG down can be hazardous to the health of a diabetic.
The factor missing from all of these studies is use of lifestyle changes, particularly diet and exercise, to achieve near-normal A1c and blood glucose levels. Repeatedly in all these studies the subjects were advised to follow the traditional (since Keyes) extremely low-fat high-carbohydrate diet and to then use medications and insulin to combat the results of that way of eating. I wrote some brief comments on the ACCORD and ADVANCE trials back in 2008 when they came out; nothing has changed since then. Unquote.
This is so typical of studies and points out why we should not rely on them for our own care. They do not consider the essential lifestyle changes that need to be made in diet and exercise. Until researchers understand the value of people and what is reasonable, studies like this will proliferate and doctors will continue to discourage people from attempting to manage diabetes to their abilities and benefit. Doctors will use studies like Alan covers to instill fear by citing them.
So now, not only is it necessary for us a patients to be more proactive in our care, but we need to be aware of these studies and how to refute them when they are used by doctors to discourage testing and bringing our A1c's closer to the normal range.
The advantages of maintaining lower blood glucose levels are less risk of heart attacks, kidney failure, neuropathy, and loss of eyesight. The disadvantage generally is listed as one problem and that is hypoglycemia. Generally hypoglycemia is listed as blood glucose readings below 70 mg/dl. I would agree that this should be the lower limit for most people and for some nearer to 80 mg/dl. I admit that I do not get concerned until I get lower than 65 mg/dl, but this is not good for most people.
I will not discuss the study from Germany that has so many flaws in it that it is easy to understand why they take the position they do. When a healthcare system is operated by the government, cost is always at issue and often best results are deemphasized at the harm of the patient. Alan at loraldiabetes does an excellent job of analyzing the study and showing its weaknesses and I urge you to read his blog about this.
I do need to quote Alan here though – Quote The problem (of the study) is not the goals but the methods. Sadly, all they have done is confirm something that has been discussed by type 2 diabetics on diabetes forums ever since ACCORD and ADVANCE (both are included in this meta-study) were published. Those papers did not show that tight control is harmful, instead they showed that intensive use of oral medications and/or insulin to push A1c or FBG down can be hazardous to the health of a diabetic.
The factor missing from all of these studies is use of lifestyle changes, particularly diet and exercise, to achieve near-normal A1c and blood glucose levels. Repeatedly in all these studies the subjects were advised to follow the traditional (since Keyes) extremely low-fat high-carbohydrate diet and to then use medications and insulin to combat the results of that way of eating. I wrote some brief comments on the ACCORD and ADVANCE trials back in 2008 when they came out; nothing has changed since then. Unquote.
This is so typical of studies and points out why we should not rely on them for our own care. They do not consider the essential lifestyle changes that need to be made in diet and exercise. Until researchers understand the value of people and what is reasonable, studies like this will proliferate and doctors will continue to discourage people from attempting to manage diabetes to their abilities and benefit. Doctors will use studies like Alan covers to instill fear by citing them.
So now, not only is it necessary for us a patients to be more proactive in our care, but we need to be aware of these studies and how to refute them when they are used by doctors to discourage testing and bringing our A1c's closer to the normal range.
19 July 2011
Low Carb Diabetes Community Not Happy With Hope Warshaw
Hope Warshaw says in her June 12, 2011 blog “As a DHCP I’ve long realized I can’t walk a mile in a PWD shoes. I can’t know what it is like day in, day out to deal with this challenging and relentless disease.” DHCP stands for diabetes educator/healthcare provider. She wisely left out educator in the acronym because she has raised the ire of many bloggers and Type 2 people with diabetes in her latest pronouncement on Diabetes Health on June 28, 2011.
So it is obvious that Mz Warshaw is not a person with diabetes. But her article did stir up feelings about low carb when she advocated high carb. What it may have done is get something out in the open to be debated by people in the know about the benefits of low carb and let the general populace know what is needed to put a stop to the obesity epidemic in our country.
In the first part of her two part article, Hope Warshaw also missed the mark by not emphasizing that prediabetes can be managed with diet and exercise if detected early enough and people are educated about this and taught to work on weight reduction and not eating high carb as she directs in part two. She seems to advocate a one size fits all approach which for Type 2 diabetes just does not work.
I will not carry this farther, but will let you read some of the articles this has spawned and the anger in some of the comments. The best and most objective blog is by Laura Dolson of about dot com. The two Hope Warshaw articles are here and here. Another excellent blog about what may be happening is here.
So it is obvious that Mz Warshaw is not a person with diabetes. But her article did stir up feelings about low carb when she advocated high carb. What it may have done is get something out in the open to be debated by people in the know about the benefits of low carb and let the general populace know what is needed to put a stop to the obesity epidemic in our country.
In the first part of her two part article, Hope Warshaw also missed the mark by not emphasizing that prediabetes can be managed with diet and exercise if detected early enough and people are educated about this and taught to work on weight reduction and not eating high carb as she directs in part two. She seems to advocate a one size fits all approach which for Type 2 diabetes just does not work.
I will not carry this farther, but will let you read some of the articles this has spawned and the anger in some of the comments. The best and most objective blog is by Laura Dolson of about dot com. The two Hope Warshaw articles are here and here. Another excellent blog about what may be happening is here.
06 July 2011
Tribute to Lost Friends
I am in somewhat of a shock this afternoon. Another friend has passed. From diabetes I think, but I am not positive as the family will not discuss the reason. I know that he has been in and out of depression the last few months.
All I have been able to find out is that he was in a coma and the doctors doubted he would ever recover out of it and the family decided to have life support stopped. I know from past conversations with him that this was his wish.
Am I affected by this – yes. This makes four friends in the last 20 months that have passed from diabetes related causes. Three from stopping dialysis and now this friend. All four had Type 1 diabetes. I cannot speak to the level of management for any of them as it was something that was seldom talked about. I can only imagine from the ages that the level of management was not what it should have been.
None of the friends or acquaintances that have Type 2 diabetes are in declining health and all have great attitudes about life. Of the six of us, five of us are on insulin and the sixth has said she is considering insulin since the rest of us are doing so well. I know from recent discussions that the A1c's range from a low of 5.4 to 6.4 and the age range is 44 to 74. It is somewhat surprising that the A1c's are almost the reverse order of our ages.
Of the remaining three Type 1 friends, I do not know what there A1c's are or have been. It is also surprising that for as much as we don't talk about our diabetes, that we keep finding others that also have diabetes. Two more with Type 1 today and one more with Type 2.
All I have been able to find out is that he was in a coma and the doctors doubted he would ever recover out of it and the family decided to have life support stopped. I know from past conversations with him that this was his wish.
Am I affected by this – yes. This makes four friends in the last 20 months that have passed from diabetes related causes. Three from stopping dialysis and now this friend. All four had Type 1 diabetes. I cannot speak to the level of management for any of them as it was something that was seldom talked about. I can only imagine from the ages that the level of management was not what it should have been.
None of the friends or acquaintances that have Type 2 diabetes are in declining health and all have great attitudes about life. Of the six of us, five of us are on insulin and the sixth has said she is considering insulin since the rest of us are doing so well. I know from recent discussions that the A1c's range from a low of 5.4 to 6.4 and the age range is 44 to 74. It is somewhat surprising that the A1c's are almost the reverse order of our ages.
Of the remaining three Type 1 friends, I do not know what there A1c's are or have been. It is also surprising that for as much as we don't talk about our diabetes, that we keep finding others that also have diabetes. Two more with Type 1 today and one more with Type 2.
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