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Tight Blood Sugar Control May Raise Risk of Death
Date:1/26/2010

iff researchers looked back at almost 28,000 people with type 2 diabetes who were taking a combination of metformin (known as Glucophage and other brand names) and a class of drugs known as sulphonylureas.

Another 20,000 individuals were taking insulin.

Risk of death for individuals with the lowest blood sugar levels (median HbA1c of 6.4 percent) was 52 percent higher than those with a 7.5 percent HbA1c. Meanwhile, those with the highest blood sugar levels over time had a risk of death 79 percent higher than the control group, which had the lowest mortality rate.

Actual causes of death were not outlined and the study was only a retrospective one, two factors giving the study less weight than a randomized controlled trial.

The heightened danger among those taking insulin might be explained by the fact that these patients generally are sicker, said Dr. Mary Ann Banerji, professor of medicine and director of the diabetes treatment center at the State University of New York Downstate Medical Center in New York City.

They also tend to be older, Bessesen said.

And it may not be an issue of how low you go as much as how you get there, said Dr. James Underberg, clinical assistant professor of medicine at New York University Medical School.

Different diabetes drugs act in different ways and have different effects on low blood sugar, he said.

Ultimately, Underberg said, "it goes back to what doctors are doing every day, fitting the guidelines to the individual."

And individuals should probably be aiming for blood sugar levels in the range of 7, Banerji said. And that is pretty tough for most people to do, she added.

Dr. Richard Bergenstal, president of medicine and science for the American Diabetes Association (ADA), said: "We need to individualize the A1c target. I don't think the message should be now everybody should be at 7.5 because that was at their sweet spo
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