Harvard Health Letter

The top 10 health stories of 2008

The year's top 10 list is a reminder that so much of health and medicine seems to reside stubbornly in the details. For example, blood sugar control as a general proposition in diabetes isn't a bit problematic. But sorting out just how low it should go, in which patients, and by what means — that's difficult. Clinical trial results steered patients and doctors away from an all-out approach that emphasizes super low levels toward a well-rounded one that takes into account cardiovascular risk factors. Similarly, we know that controlling high blood pressure is important, but clinical trial results laid to rest some old theories by showing that this is also true for people ages 80 and older.

We're just as enthusiastic as anyone about advances in stem cells research (see item 4) and genomics (see item 5). But it gives you a sense of complexities and the long road ahead if basics like blood sugar and blood pressure are still being worked out.

 1. Blood sugar limbo: How low should it go?

People with type 2 diabetes are encouraged to keep their blood sugar levels low, and the usual goal is a glycated hemoglobin (HbA1c) level of 7% or lower (the percentage of "sugary" hemoglobin is a good way to assess blood sugar levels over time, rather than depending on the snapshots of single blood sugar measurements). But is 7% ambitious enough? Results from three clinical trials showed that the single-minded pursuit of low blood sugar levels is probably not the best approach to type 2 diabetes, particularly in people ages 60 and older.

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