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Tight Blood Sugar Control in Older Diabetics May Not Reduce Heart Risk
Date:6/29/2010

the remainder of the five-year follow-up, which ended in June 2009.

In this new analysis, the researchers looked at kidney, eye and nerve problems. The intensive therapy did not reduce the risk of problems such as advanced kidney or eye complications. But it did delay the onset of albuminuria, protein in the urine, which is associated with renal failure, and some eye complications and nerve problems.

But those on tight control also gained more weight and were at risk for very low blood sugar, the study found.

The researchers concluded that: "The observed benefits associated with intense glycaemia management should be weighed against higher total and cardiovascular-related mortality, weight gain, and severe hypoglycaemia in patients at high risk of cardiovascular disease."

"A target of 6 percent or less with present strategies seems imprudent," the researchers wrote.

In a commentary accompanying the study in The Lancet, Dr. Ronald Klein of the University of Wisconsin School of Medicine and Public Health, Madison, noted the three-fold increase in severely low blood sugar found in those on intensive therapy. Technological improvements are needed, he said, to normalize blood sugar without causing it to drop dangerously low.

It's not surprising that no benefits were found for all complications, Klein said. "The study didn't really go long enough," he said, to observe the protective effect of intensive therapy on some complications.

Even so, he added, it's still crucial to control blood sugar -- perhaps just not as intensively as researchers previously thought necessary.

Other researchers in a subgroup of the ACCORD study reported online June 29 in the New England Journal of Medicine that tight glucose control helped reduce the progression of retinopathy, a common complication of diabetes that can cause blindness.

Looking at 2,856 study participants, the subgroup researchers found that the rates of pro
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