(This study, which went back into older Joslin records, used higher cutoffs because the trend in previous years had been to allow higher A1c levels than today.)
In other words, patients with the genetic defect and poorly controlled BG levels had increased mortality rates. But just having the genetic defect did not increase mortality. It was only a combination of having the genetic defect and also having long-term high BG levels that caused the increased risk of death within the 10-year period. [We all have a 100% risk of death, although as someone wisely pointed out, the evidence is purely annecdotal.]
This could be true of the other dire predictions for people with diabetes. The increased risk for Alzheimer's disease, for example, might be the result of high BG levels rather than the underlying disease itself.
Most researchers assume that having diabetes is synonymous with having high BG levels. Often it is. But it doesn't need to be. And although we can't reverse the fact that we have diabetes, we can help to control our BG levels.
The A1c cutoff levels used in these studies were fairly high according to the standards of many people. Even the ADA says A1cs should be under 7. Endocrinologists prefer the A1c to be under 6.5. Many patients aim for A1cs in the normal range, under 6. And Richard K. Bernstein, the type 1 guru of the low-carb diet for people with diabetes, wants his patients to achieve A1cs in the 4s.
Diet and exercise definitely help. Many people find that low-carb diets result in plummeting BG levels without drugs. If these aren't enough, we need to insist that our doctors prescribe medication that will help. Insulin is often the simplest therapy, with the fewest long-term side effects. And for those without good drug coverage, even an expensive basal insulin is cheaper than three or four expensive new diabetes drugs.
There are many people with diabetes who have A1c levels of 8 or 9 or even higher; this is simply not acceptable. Of course not everyone has the deleterious genes described in this study. But there are undoubtedly other factors that, like this gene, can harm us when we let our BG levels get too high.
It's not easy. But controlling our BG levels is worth the work. It's not simply having diabetes that causes complications. It's having high BG levels.
