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Intensive blood sugar control doesn’t have lasting cardiovascular benefits for those with diabetes
- By Medha Munshi, MD, Contributor
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Tight control in older age more often is deleterious than a bit liberal control in ground reality.Needs explanation and scientific data to back up. Anyone to support the postulate?
A lot of money spent to learn that self-control with regard to eating improves your health, and that reverting to uncontrolled eating habits kills the benefits all the efforts achieved.
Influence of dietary restriction / correction in an increasingly fragile physiology , and the effect of drugs in an altered Internal mileau related to organ (dys)function could be the reason why tighter targets may be not as beneficial. Further the elderly included in clinical trials may be minuscule for any meaningful conclusions to be drawn. Most important aspect of elderly Diabetes care is to prevent hypoglcemia . Prof ME Yeolekar , Mumbai.
Very useful and educative.
Me at 82 am a Diabetes II patient since last 10 years.
My opening Glycemic Index was around 7.2 10 years ago.
By extreme selected diet control ( I am a Vegetarian)
and medicine Glycomet 250 mg, ( Metmorphin) I had brought it down HbA1c to 5.4 only.
I stopped eating even a grain of sugar, sugar product, anything sweet , nil carb but limited protein diet having a total daily Calorie of 800/850 ( (Newcastle Diet)Dirt)reduced weight from 195 pounds to 165 pounds in 2 years .( without any excercise as My knees are damaged and am restricted to limited walking) My doctor, Dr. J. Srikant then advised me that due to my older age I should not bring down HbA1c to such low level but maintain it around 6/6.5, which I am following .
I also had BP around 170/95 10 yrs ago and same doctor prescribed me medicine, a combination of Telmesartin
and Amlodipine 40/5 mg(Trade name TAZLOC M) ( from the first day10 yrs ago till now) and till that time my BP remained normal at 130/80 for all these 10 years.
All four right side RRRB in my heart are completely blocked but I did not have any heart complaint till today. I am also a patient of well enlarged Prostrate for which he prescribed Tamsulosin 0.4 mg- (Trade name
URIMAX 0.4 mg) and a homeopathic medicine named
SABAL SERULETA -Q Strength ( meaning Mother Tincture)- 10 drops ( without water) twice a day.
The prostrate does not give me any trouble and have very smooth flow. It has not enlarged any further since last 10 years. I go to pee in night for once or max two times in night and have sound sleep ( hit the bed and fall asleep).
How are they controlling blood sugar levels, unless you do it by severe reduction of refined carbs and sugar, taking pharmaceuticals to force the blood sugar into cells that can’t use it is quite pointless. We need to address the root cause, not the symptoms.
This information is very informative
A1C of 6.9 is not tight control, they need to do the study they study said they were going to do and actual control the blood sugar and get it down under 6 or lower. I am type 1 and my A1C is 5 and has been for many years so it is possible so do the study and then see what happens.
This article doesn’t say what the intensive management involves. If it involves giving insulin or sulfonylureas, of course there’s no benefit. These do nothing to reduce the body’s sugar load, and they increase insulin levels. SLGT2 drugs actually get sugar out of the body. As does intermittent fasting and low carb eating. I’m doing those three things and I’ve gotten off of four medications, while my a1c is almost normal. Not easy, but worth it.
Why isn’t there anything in this study about a healthy way of eating?
(The American Diabetes association has recently published information about eating a healthy ketogenic diet to reverse type 2 diabetes. )
The title and the way this article is framed leads people with long standing diabetes away from good blood glucose control. Yes the results do not show a significant difference in CV risk at 15 years, but notably A1C values also did not differ. This points to a problem with maintaining good control.
“Intensive control” with what ? Medications ? I’d love to see the difference of those under “ intensive control “ with diet alone as opposed to control with medications- medications are treating the symptom of high blood glucose – the underlying disease is still doing its damage , whereas lifestyle changes treat the actual disease 🤔
What other factors were tracked? Was family history considered, genetic predisposition, lifestyle (exercise, eating habits/patterns, sleep hygiene, BP, inflammation markers, any drug usage, social status…) I did not read the entire study but this article nowhere does it mention all of those factors. Yes, I lowered my A1C but I kept eating processed foods and stayed till midnight watching TV and had delicious, sugar laden cereal, and had minimal daily movement…what the fack do you expect.
How about a whole food plant based diet with very little oil intake. That walk about 2 mile’s every day and you too can out live all your doctors.
Heal yourself and save the world, Vegan for the win!
Half of us, including people without diabetes (who have low A1Cs) are going to die from cardiovascular disease. It is the food!!! Until we switch to a whole-food plant-based diet that is low in fat, cv disease will continue progress. Good blood sugar control on healthy foods should be the goal – and science is clearly pointing to healthy foods as whole-food (not processed, no oil) and plant-based (veggies, fruit, legumes, whole intact grains, nuts, seeds, spices and herbs). The science is clear. It is the food! (Other lifestyle changes, like moving your body, meditating, and sleeping well certainly help.) But good blood sugar control while eating meat, cheese, eggs and oil leads to chronic disease for all of us. Nutrition research is clear on this. Aim for fruit and vegetables with every meal. Beans, greens, and berries are us!!! Keep reducing meat, dairy, and egg. We can do this!!!!! Our bodies will thank us by feeling so much better.
If you wish to eliminate cardiovascular risk and other metabolic ailments that are associated with T2D, eliminate carbohydrates from the diet.
Keep it up, hope a solution will be found in future. I am also a type 2 diabetic patient.
Nice and informative article
The BSControl over longterm helps to allay any complications that may arise and definitely helps in overall reduction in peripheral nerve damage.
Thus, saving unwanted surgery n further loss of body parts to surgery.
Just be conscious and take an array of vitamins along with the medication to protect the vital organs.
Aim for more of low glycemic index foods along with an intake of at least > 20 grams of fiber.
Such foods also help to maintain a healthy gut microbiota.
It is well known that duration of diabetes is the reason for complications.
Older adults with 12 years of diabetes have already developed atherosclerotic plaques which dislodges and give heart attacks and strokes. Intensive control of sugar is not going to dissolve the plaques at this stage.
As vessel ages these patches are going to dislodge one day.
Older diabetes with plaques would benefit of cyclodextrin which regress the plaques, inaddition to intense sugar. control.
The therapeutic approach to managing diabetes is to lower the patient’s blood glucose level. Not much attention is being paid to hyperinsulinemia. Isn’t hyperinsulinemia just as bad as, if not worse than, hyperglycemia when it comes to long-term adverse health consequences?
Please where is the definition of intensive blood sugar control?
Are we talking hypoglycaemics and insulin,
Or are we talking intensive dietary change?
Were both assessed?
Type 2 diabetics could read this and interpret “what the heck, I might as well just give up”
Will read the report, but many people just read the headlines, and these could be misinterpreted I think
I’m a female, age 62, very slightly overweight, active, diagnosed 7 years ago and my A1c is 5.6. I intend to continue to practice tight blood glucose control and live a quality life ’til at least 90!
It is a shame that Harvard Medical School should even be talking about pharmaceuticals for type 2 diabetes. Have they heard of the work of Dr. T. Colin Campbell. I followed his Whole Food Plant-Based low fat no animal protein diet and reversed diabetes type 2 in just two weeks. Whereas the President of AHA had his heart attack at 52, Dr. Campbell in his 80s is no only CVD free but is an epitome of health and even said in one of his lectures that he does not use any medicine. Harvard Medical School please promote his protocol and not pharmaceuticals and teach the new generation of Doctors of the superiority of Lifestyle Medicine over allopathic medicine. Thanks.
Your always doing testing, studies and TV commercials on T2 when the hell are you going to advocate T1, the diabetes community is truly asinine in regards to real diabetes care.
” Newer classes of diabetes medications, such as sodium glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists appear to have CV benefits and low risk of hypoglycemia, and may be considered as well.” Helpful that new medications are being developed but what’s the price tag? how many people in the US will be able to afford either if either or both would be helpful for their DM?
Do you think that, Obesity, NAFLD, Pre Diabetes, Type 2 Diabetes, all have the same cause? I do. So simply drilling down the glucose for its own sake will have little effect on CVD. Because it is not the glucose that is the problem. Did your study measure insulin levels? Did your study look at sub populations who might have done better and analysed their diet? It could be that the make up of the diet was driving the disease process in those people vulnerable. And finally, did any of your study participants go into remission?
Ask the PBMs who abscound 50% of the list price of the drug and rarely pass that on to the patient.
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