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Effect of Strict Diabetes Control on Heart Still Unclear
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Page: << Prev | 1 | 2 | 3 | Next >> Type 2 diabetes, which affects some 24 million Americans, can result in devastating complications such as kidney disease, amputation, blindness and heart disease. A common test for measuring blood sugar levels looks at hemoglobin A1C values spread over two to three months.
"The central role of glucose control in preventing microvascular eye, kidney and nerve disease is fairly well-established," said Dr. Rick Bergenstahl, executive director of the International Diabetes Center in Minneapolis and ADA's president-elect of medicine and science. "Data related to macrovascular effects on the heart are less well understood or less conclusive."
Research presented last year on the ACCORD trial found that intensive lowering of blood sugar in people with poorly controlled type 2 diabetes did not have a significant effect on reducing cardiovascular events, such as heart attack and stroke. In fact, it appeared to raise the risk of death.
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At the time, scientists speculated that the increased mortality risk was due to low blood sugar, but this turned out not to be the case.
Instead, "people who achieved a rapid and sustained reduction of A1C from higher levels at the beginning had the lower risk, and the ones who were unable to rapidly reduce glucose from the beginning had the higher risk," Riddle explained. In other words, those who struggled to get their glucose under control seem to be at higher risk for heart trouble.
Meanwhile, analyses from the VADT trial indicates that intensive diabetes treatment begun earlier after a diagnosis is more likely to do good, while intensive treatment started 15 years after diagnosis is more likely to do harm.
Starting rigorous control of blood sugar two decades or more after a diagnosis of diabetes actually upped the risk of cardiovascular problems, at least in this population of mostly older males.
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Copyright © 2009 ScoutNews, LLC. All rights reserved.
Last updated 6/9/2009
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SOURCES: Helena W. Rodbard, M.D., medical director, Endocrine and Metabolic Consultants, Rockville, Md., past-president, American Association of Clinical Endocrinologists and past president, American College of Endocrinology; June 9, 2009, teleconference with Richard M. Bergenstahl, M.D., executive director, International Diabetes Center, Minneapolis; Matthew C. Riddle, M.D., professor, medicine, Oregon Health Science University, and member, ACCORD Glycemia Management Group; and William C. Duckworth, M.D., director, diabetes research, Carl T. Hayden VA Medical Center, Phoenix, and professor, clinical medicine, University of Arizona, and co-chair, VA Diabetes Trial
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