Both studies left us with a lot of questions.  The main question I come away with is, Are Normal Blood Sugars for People with Diabetes Good or Bad? 

The DCCT trials and the UKPDS trial tell us that lowering blood sugars are good for you.

Common sense says that if you can normalize your blood sugars, you can prevent a number of diseases.  It is hard to imagine that keeping your blood sugars at an A1c of 7% or a blood sugar of 170mg/dL is good for you when a normal blood sugar for a healthy person without diabetes is about 85-87mg/dL.

If you look at the ADVANCE and ACCORD studies, you see that everyone had out of control diabetes for many years, they mostly had cardiovascular disease, they were mostily overweight and obese which made them more insulin resistant.  They were all on industrial doses of medications for hypertension, diabetes, cholesterol, etc.

They were probably still eating poorly and eating large amount of carbs and not being very physically active.

So if you take all of these into consideration, it doesn't seem that unlikely that you might see an increase in death when you aggressively try to lower their blood sugars.

What I take away from the 2 studies is that if you have had out of control diabetes for more then a couple of years, then you need to educate them on nutrition and physical activity first and slowly bring down their A1c levels and then slowly make changes to their medications.  

It just makes no sense that we leave patients A1c's at levels that we know can cause complications and put people at risk for other medical problems.

Steve Freed, R.Ph., CDE

Publisher: www.diabetesincontrol.com

email: publisher@diabetesincontrol.com