August 30, 2006

More Bad Science? "Treating Post Prandial Hyperglycemia Does Not Delay Progression of Early Type 2 Diabetes"

Diabetes in Control reports on yet another pooly designed study sure to set back diabetes treatment.

The study, STOP-NIDDM gave people Acarbose (Precose) to see if it would delay onset and progression of diabetes. Precose is a carb blocker which I took for several years, so I know quite a lot about it.

The simple version of their finding is that using Acarbose to lower post-prandial blood sugars in people with fasting blood sugars near 125 mg/dl did not keep those blood sugars from rising to 140 mg/dl though it slightly lowered A1c.

What the article DOESN'T point out is that Acarbose only effectively blocks the equivalent of about 10-15 grams of carbohdrate, but the subjects in this study were told to eat a "healthy low fat diet" so they were eating more like 100 grams per meal.

So while their post-prandials might have been lowered from wretched (220-275 mg/dl) merely nasty (180 - 225 mg/dl) they could not have come anywhere near the normal level that it takes to prevent organ damage, including destruction of beta cells!

In addition, by the time someone's fasting blood sugar is in the 120s, as these subjects' were, Precose no longer eliminate spikes, it merely pushes them back a few hours. So testing at 2 hours post-prandially will miss the fact that at 3 or 4 hours the blood sugars are spiking dangerously high.

So the real conclusion of this study is not that controlling PP blood sugar doesn't delay progression of Type 2, it is that any treatment that doesn't NORMALIZE post prandial blood sugars but allows them to go over 140 mg/dl several times a day is a death sentence to beta cells, nerves, kidneys, and retinas.

Sadly, that probably isn't the message that doctors will be getting from this. After all, why tell your patients to test after meals when "research shows" that lowering post meal blood sugars doesn't do anything for them.

Meanwhile, on a related note, it's 8 years since my diagnosis this week and my recent blood work shows completely normal kidneys. My random fasting blood sugar was 86 mg/dl. I have no neuropathy in my feet except for that caused by my crushed lumbar discs. My retinas are perfect. My blood pressure yesterday was 120/80 without any BP meds. Over this entire 8 years I've kept my blood sugar truly normal using whatever it takes, low carb diet, then metformin, and now pre-meal insulin, and it is definitely paying off for me.


Anonymous said...

thank you for providing more information on this study.

i read it and it echoed what my "fired" doc said to me: give up, you can't do anything.

the study itself will only give credence to the general practicioner/endo who hasn't done continuing ed.
think how many people will be hurt by this!

Lili said...

I can't figure out why acarbose would delay progression, either!

As an aside, my PCP told me he'd never had a patient successfully complete a month on acarbose because the side effects are so bad.

Jenny said...

Re "Give up, you can't do anything" do read Do People with Diabetes Always Deteriorate to see why doctors believe this and why it is wrong.

Re: Acarbose and progression. Acarbose is tolerable if you do the following:

1) Don't ever eat more than 30 grams of carbs at one time!

2) Only use it once a day.

I found it helpful for allowing occasional indulgences while on a strict low carb diet. But if taken more than once a day and with too many carbs, fegettaboutit!