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Tight Blood Sugar Control May Not Harm Diabetics
Date:4/28/2010

e in A1C levels, there's a 15 percent to 20 percent higher risk of cardiovascular disease. And, in addition, as A1C levels rise, so do the risks of kidney disease, eye disease and nerve damage.

To achieve A1C levels of less than 6 percent, most people with type 2 diabetes would need a combination of medications and aggressive lifestyle changes, such as losing weight and exercising a lot more often.

Initially, the ACCORD study was scheduled to last for almost six years, but the study was stopped during the third year when the researchers discovered the increased death rate. At the time, there were 257 deaths in the intensive group vs. 203 deaths in the usual treatment group.

When Riddle and his colleagues re-examined the data, they found that people in the intensive treatment group who still had higher A1Cs were most at risk of mortality.

Results of the study were published in the May issue of Diabetes Care.

"We need to know what it is about those who couldn't lower their glucose levels that puts them at greater risk. We need to find more specific red flags for clinicians to look for," said Riddle.

He added that although most people would like a standard set of goals and advice for everyone with type 2 diabetes, "there's no one-size-fits-all approach. There are different treatments for different groups, and we need more sophisticated assignment to subgroups for treatment."

"I think what this paper reveals is that it was not simply the low A1Cs or improved glucose control that account for the higher death rates, and that's reassuring. It shows that many people can safely achieve good glucose control," explained Dr. David Kendall, chief scientific and medical officer for the American Diabetes Association.

"It appears that those who continued to attempt medication titration and other changes without success are most at risk. Their diabetes may be more challenging somehow or the
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