Monday, September 12, 2011

Are Glucose Guidelines Too Strict?

Are Glucose Guidelines Too Strict: There is a radical new idea being discussed in diabetes care. If you read articles here long enough you will find experts that advocate very strict control of blood glucose. Some medical practitioners are now saying it may be time to lighten up a bit on treatment options.

For this report we are relying heavily on a self-penned article by Dr. John Morley in the stltoday.com website. Morley begins by stating, “As an endocrinologist, I have spent more than 30 years trying to lower the sugar levels in diabetics to a normal level. As a diabetic, I have tried to keep my fasting glucose level below 100 mg/dl (milligrams per deciliter) and my hemoglobin A1C (or glycated hemoglobin level) below 6 percent.”

It should be noted that as a diabetic Morley has a vested interest in keeping his own glucose levels under control, yet it seems he struggles with new information, “Three studies conducted during the past couple of years are causing me to rethink my approach to treating diabetes.

“The most dramatic was published this year. Craig Currie and his Cardiff University colleagues examined two groups of more than 20,000 patients in the United Kingdom who were being treated for diabetes. Members of both groups were at least 50 years old. The researchers found that those who were least likely to die had a hemoglobin A1C of 7.5 percent. This is higher than the American Diabetes Association’s recommended hemoglobin A1C level of 7 percent or lower. Those who took insulin, researchers said, had worse outcomes,” said Morley.

In scientific times past there were instances where beliefs were challenged with new information and resulting changes provided improved health care, but does this new information really mean A1C levels no longer matter? Morley continues, “The finding has created a major conundrum for those of us who are diabetic or treat people with diabetes. Rather than trying to reduce the glycated hemoglobin level to close to normal, we should try to keep a patient’s HbA1C in the range of 7 percent to 8 percent. Further support for this strategy comes from studies in older people that suggest patients with HbA1C levels below 7 percent are more likely to fall.

“The reasons for these findings are uncertain. Possibly tight control of glycated hemoglobin levels leads to a condition called hypoglycemia, which occurs when blood sugar levels dip too low.”

Morley then discussed the potential for new diabetic drugs to interfere with normal heart health or provide accumulated fat that can clog arteries. It almost seems as if Morley may be considering the potential of returning to a more simplified approach to managed care.

Morley concludes by asking and answering his own question, “So how will I treat diabetes? Of the medicines for diabetes, the drug that has clearly been shown to decrease death is metformin. The bottom line: I’ll suggest my patients who have type 2 diabetes use metformin and make lifestyle changes — especially exercise — which is the treatment of choice.”

It is interesting that no matter where a medical practitioner ultimately stands on the pharmaceutical side of diabetes care the common denominator in overall health care seems to revert to lifestyle alterations that include watching the foods you eat and working to maintain a healthy weight through exercise. These two approaches can help avert diabetes and can help lessen the effects post-diagnosis.
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