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Tighter Blood Sugar Control Not Best for Some Diabetics
Date:12/15/2009

Other medical problems must be weighed first, study finds

TUESDAY, Dec. 15 (HealthDay News) -- Tight blood sugar control needn't be the end-all factor for people with type 2 diabetes who have other medical problems, a new study indicates.

The degree of blood sugar control in type 2 diabetes "has been a subject of controversy for a decade," said Dr. Sheldon Greenfield, a professor of medicine at the University of California at Irvine, and lead author of a report in the Dec. 15 issue of the Annals of Internal Medicine. "Our work attempts to reconcile these contentious issues."

Greenfield and his collaborators followed 2,613 people treated for diabetes at clinics in Italy for five years, measuring the benefit they received in terms of reduced heart attacks and other cardiovascular problems from achieving blood glucose levels lower than 6.5 percent, slightly below the 7 percent level that is generally recommended. They found that those benefits were directly related to the presence of other medical problems -- more problems, less benefit.

The accompanying problems were listed by using a widely used Total Illness Burden Index, which includes conditions affecting a number of systems -- heart, gastrointestinal and foot -- with a heavy emphasis on cardiovascular issues such as high blood pressure and high cholesterol.

Blood glucose levels below 6.5 percent were associated with a lower risk of cardiovascular events in people with low to moderate levels of accompanying problems, but not in those with a high level of such problems, the study found. The same was true for a glucose blood level of 7 percent.

"The message for people with lots of other medical conditions is that their life can be easier, they can ease up a bit on blood glucose levels and focus on the other medical conditions they have," Greenfield said.

But for those people, he quickly added, "you don't want blood sugar to be v
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