Net Benefit of Intensive Diabetes Tx Questioned

Medpage Today ^ | 07/27/11 | Crystal Phend

[Pining_4_TX]

Intensive glucose management for type 2 diabetes holds only modest benefits at best and should be approached cautiously due to increased hypoglycemia, researchers warned in a meta-analysis.

The only significant benefits of intensive treatment were a 15% reduction in risk of nonfatal myocardial infarction and 10% lower risk of microalbuminuria, Catherine Cornu, MD, PhD, of the Hôpital Louis Pradel in Bron, France, and colleagues reported online in BMJ.

But pooled results of 13 randomized trials showed no reduction in all-cause mortality or cardiovascular causes of death, the primary outcomes, and more than a doubling in severe hypoglycemia.

"Intensive glucose lowering treatment of type 2 diabetes should be considered with caution and therapeutic escalation should be limited," the group warned in the paper.

An accompanying editorial called the results consistent with prior evidence for "modest at best" benefit.

[Pining_4_TX]

I hope the link works. This site is primarily for medical professionals, so you might have to sign up to have access.

[Pining_4_TX]

I hope the link works. This site is primarily for medical professionals, so you might have to sign up to have access.

[Ciexyz]

What is intensive glucose management, is it taking a pill like Metformin.

[chuckles]

I Googled it and that's what they are talking about. If you take medications to lower A1c levels rather than diet, the medications seemed to have no effect on heart and stroke outcomes. There were conflicting reports so take it with a grain of salt.

I guess what they are saying is the Metformin may help sugar levels, but a diet does better to stop blindness, heart attacks, strokes, and neuropathy.

IMHO, it may be because I could eat a half a pie and then a couple of Metformin to kill the sugar effect. I'm not sure anybody knows for sure. I'm always suspicious of someone holding fast to a number. Better diet would have to be better than a pill, IMO.

[Hardraade]

“Intensive” means a pill like metformin, often in conjunction with something like Januvia, plus tight sugar monitoring and use of insulin at meals and during the day.

The trouble with that is that often the insulin effect is difficult to calculate, and you end up too low, which is harmful in itself.

[Pining_4_TX]

Intensive management means doing whatever it takes (often multiple drugs in increasing dosages) to maintain a low A1C value. They are attempting to use drugs to force a diabetic’s blood sugar levels to what they consider to be normal levels. The hazards to this course of action are proving to be greater than any benefit that might occur.

In fact, no study has shown that lower glucose levels do much except produce lower numbers on the test. It is like curing your cough when you have pneumonia. The drugs used to lower blood glucse give no better results than standard diet and exercise therapy.