Latest research suggests tight glucose control for diabetics

Jun 9 2008

The latest research into diabetes has come up with some interesting results.

It has been found that keeping tight control of blood sugar levels in type 2 diabetics reduces the risk of kidney disease by 21 percent, and that weight gain, the use of multiple drug combinations and getting blood sugar too low, too quickly may all have been factors in causing early deaths.

The research into blood sugar levels has found that intensive glucose control brought blood sugar levels below or down to standard glucose control recommendations.

In a study where at the outset the average hemoglobin A1c was 7.5% amongst 11,000 patients randomly selected to undergo intensive glucose control, over a 5 year period a target A1c level of 6.5% or lower, was achieved.

At an average follow-up of 5 years, average A1c fell to 6.5% in the intensive group compared with 7.3% in the standard group.

Dr. Anushka Patel of The George Institute for International Health in Sydney, Australia, says no evidence of an increase in cardiovascular deaths or deaths from all causes was seen with intensive glucose management.

Dr. Patel says their study Advance found there was a 10% decrease in overall heart-related "events," and the risk of kidney disease was decreased 21% with tight blood sugar control.

This is in direct contrast with the findings of another study, called Accord, carried out earlier in the U.S. which was stopped when it appeared that intensive glucose management was associated with an increased risk of death.

Dr. Hertzel Gerstein of McMaster University in Ontario and colleagues found that five percent of patients given intensive drug treatment in Accord died of any cause during the 3.5 years before the trial was stopped, and cardiovascular deaths were also higher among those who got more treatment.

Both studies were designed to measure the benefits of using drugs to dramatically lower blood sugar in diabetes but there were some key differences between the Advance and Accord studies.

The Accord trial involved 10,000 patients whose hemoglobin A1c was 8 on average, and the goal was to get it down to 6 which was possibly too low as they appeared more likely to have severe low blood sugar crises that required medical help.

The Accord group also took a greater variety of drugs from several classes, had their prescriptions changed more often and also gained more weight - which in itself would have had an impact on the risks and symptoms of both diabetes and heart disease.

Patients in the intensive arm of Advance were treated primarily with moderate-release gliclazide, a drug in an older class known as sulfonylureas whereas in Accord they were given a new class of drugs called rosiglitazones.

Many experts believe the goal should be to get average blood sugar levels as measured by hemoglobin A1c to 7 and no lower.

Experts suggest that in the Accord trial weight gain, the use of multiple drug combinations and perhaps even getting blood sugar too low, too fast may all have been factors in causing early deaths.

Many experts believe the goal should be to get average blood sugar levels as measured by hemoglobin A1c to 7 and no lower.

Dr. Patel says the results suggest that the guideline recommendations for tight glucose control are appropriate.

Details of both trials were released online in the New England Journal of Medicine on Friday and reported at the annual meeting of the American Diabetes Association.