Diabetes damages each part of the body, the brain in the feet. A high blood glucose, characteristic of diabetes wreaks havoc on blood vessels. It makes sense that keeping blood sugar levels under control to prevent damage related to diabetes - but how to push blood sugar is an open question."Strict control of blood glucose represents a new era in diabetes care," said Dr. David Nathan, professor of medicine at Harvard Medical School and director of both the Clinical Research Center and the Center for Diabetes Massachusetts General Hospital.
The hazards of high levels of blood sugar
Type 2 diabetes is characterized by high levels of blood sugar. Over time, hypertension sugar damages small blood vessels throughout the body. This is called microvascular disease. The damage can lead to kidney failure, nerve pain, amputations and blindness.
But the main cause of complications and death in people with diabetes is cardiovascular disease, which affects larger blood vessel of the body. (This is also known as macrovascular disease.) About two-thirds of people with diabetes die from heart disease, stroke and other cardiovascular problems.A good measure of sugar in the blood is tested for hemoglobin A1c (HbA1c).
Reveals the average concentration of sugar in the blood of a person over the previous three months. People without diabetes have HbA1c 5.7%; HbA1c of 6.5% or more usually indicates diabetes.
For some people with type 2 diabetes, a healthy diet and regular exercise can keep the blood sugar under control, but many also need medication. People with diabetes are normally invited to aim for tight control of blood sugar, resulting in an HbA1c below 7%.
Research has shown that tight blood glucose control can reduce the risk of microvascular complications. But the effect of tight control of blood sugar in cardiovascular diseases was murkier. The new report suggests NEJM tight blood sugar control also has cardiovascular benefits.
The benefits of tight control
The report is 10 years followed Veterans Affairs Diabetes Trial. This study involved 1,791 veterans with type 2 diabetes who were on average 60 years. These veterans were randomized to therapy "intensive" intended to put sugar in the blood to a lower target HbA1c, or "standard" therapy with a higher HbA1c target. In each group, the level of sugar in the blood objective was achieved with a combination of oral drugs for diabetes and insulin injections, if necessary.
During the trial of five and a half days, the intensive therapy group had an average HbA1c level around 6.9%. The standard treatment group had a mean HbA1c of approximately 8.4%.More than 1,600 trial participants were followed for five years. Meanwhile, the researchers compared the number of participants had a cardiovascular event such as heart attack or stroke between intensive therapy and standard therapy groups.
The results were encouraging for both physicians who defended the control of blood sugar and people tight with diabetes who have worked hard to achieve. Heart attack and stroke risk in the strict control group was 17% lower than in those whose blood sugar floated a little higher. This translates into about 9 fewer heart attacks and strokes per 1,000 people.
Metabolic memory
The studio had another positive result. It reinforced what Dr. Nathan calls "metabolic memory". As he explains, "an early intervention period appears to have lasting effects over time."The active part of the VA trial lasted about five and a half years. After that, the health care of veterans were more supervised by the team of the research study. In three years, the average HbA1c in the intensive therapy group had slipped up, reducing the level difference between the intensive group and 1.5% standard to somewhere between 0.2% and 0.3 %. Yet the intensive therapy group continued to reap cardiovascular benefits years later.
The effect of intensive treatment do not last forever, says Dr. Nathan. At some point, he says, "metabolic memory becomes metabolic amnesia." But the more you keep your blood sugar under tight control, the more benefits tend to last.
Balancing Act
Although tight control of blood sugar can help prevent diabetes-related damage, it has some drawbacks. People in order to strict control may experience low blood sugar episodes in the blood (hypoglycemia), which can be very dangerous. Tight control can also be difficult, sometimes requiring several medications that can have adverse side effects of their own.
Previous research had suggested that people with longstanding diabetes and heart disease may not benefit from established a strict glycemic control as well as people with newly diagnosed diabetes. But the new report NEJM shows that it is never too late to control blood sugar.
Although tight control of blood sugar can help prevent diabetes-related damage, it has some drawbacks. People in order to strict control may experience low blood sugar episodes in the blood (hypoglycemia), which can be very dangerous. Tight control can also be difficult, sometimes requiring several medications that can have adverse side effects of their own.
Previous research had suggested that people with longstanding diabetes and heart disease may not benefit from established a strict glycemic control as well as people with newly diagnosed diabetes. But the new report NEJM shows that it is never too late to control blood sugar.
Veterans who participated in this study had poorly controlled diabetes for several years before the start of the study. And 40% had cardiovascular disease when they enrolled in the trial. So not only intensive treatment to reduce the risk of cardiovascular
disease, it was in the elderly longtime diabetes, many of which already
had heart problems.
Good control of blood glucose is important for all people with diabetes. Current guidelines from the American Diabetes Association recommends a target HbA1c less than 7%. But the guidelines also recognize that there is no single rule size. If you have diabetes, check with your doctor if tight control of blood sugar is good for you.
Good control of blood glucose is important for all people with diabetes. Current guidelines from the American Diabetes Association recommends a target HbA1c less than 7%. But the guidelines also recognize that there is no single rule size. If you have diabetes, check with your doctor if tight control of blood sugar is good for you.
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