Controlling blood sugar levels in diabetes: How low to go, from Harvard Men's Health Watch

New studies are prompting doctors to re-examine a fundamental treatment question: what level of blood sugar is best? The debate has focused on the level at which people with type 2 diabetes should try to maintain their blood sugar. Randomized trials haven't completely answered the question, reports the January 2011 issue of Harvard Men's Health Watch,

but they offer some direction. Here's what some recent major studies found:

  • The ACCORD study was halted early, after three-and-a-half years, because the death rate had increased among the participants receiving treatments aimed at intensive control of blood sugar.
  • Another study found that five years of tight blood sugar control provided protection against complications of diabetes involving small blood vessels (including damage to the kidneys, nerves, or eyes) but not against heart attack or stroke.
  • A study of veterans found that after more than five years, rates of complications and death were the same in those assigned to tight blood sugar control and those assigned to standard control.
  • A British study found that participants with moderate blood sugar control experienced fewer cardiovascular problems and were less likely to have died during the trial than those with strict control or minimal control.

Harvard Men's Health Watch notes that these trials and other research have modified some assumptions about the treatment of diabetes. Still, some principles seem clear:

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