The one problem with my diabetes site is that the page names are computer generated and hard to remember. So I just put together a new, easy to remember link that will take you to the page that describes how to get your blood sugar under control. This is my rewritten, updated version of the Jennifer's Advice page that is posted around the web and which has helped thousands of people join "The Five Percent Club."
Either version will work:
http://bloodsugar101.com/testtesttest.php
http://phlaunt.com/diabetes/testtesttest.php
This should make it easier to remember the link so you can pass it on to friends who might find it helpful.
====
In other news, I just received word that J.C. Hartmann, one of the founders of the alt.support.diabetes newsgroup and one of the first promoters of the "5% club" concept has died at the much too young age of 57. I do not know the details, but I do know that the world has lost a wonderful, helpful person.
Alt.support.diabetes during its heyday was a supurb source of support and information for people with diabetes. It became overwhelmed with spam over the past couple years and I no longer recommend it, but without it I would not have anywhere near the understanding of how many different ways people have found to control their diabetes and recover normal health.
Quite a few of the early web diabetes pioneers have passed on. Ottercrittr and Jude Crouch, for example. They both died of cancer. Both were very good people who left enduring legacies in the help they gave to others.
February 18, 2009
February 16, 2009
Type 2 Diet Poll Results
UPDATE: Added 7 more data records collected from posting poll of Low Carb Friends discussion board. All statistics were reanalzyed, but the medians did not change.
I also added an analysis of the data from those who maintained weight losses for 5+ years.
===
I've taken the information contributed by people who responded to the poll in the comments posted to the previous post and done what I could to standardize the responses in a way that makes it possible to analyze this data.
Fifty-one people contributed data. Of these 49 had Type 2, 1 had MODY and 1 had Type 1.
Two reported a weight gain.
One maintained a stable weight for 40 years but is probably not a Type 2.
Three reported no weight loss or a completely regained the weight they originally lost.
Weight Loss
Of those who lost weight and maintained some of that loss, 42 contributed information which allowed me to calculate what percentage of their starting weight they were able to lose and maintain.
The time framee people reported for their diet ranged from 40 years to just started, with a median time of 2 years.
The amount of weight loss that had been maintained ranged from 190 to 6 pounds, with a median maintained loss of 50 lbs.
The percentage of starting weight that was maintained ranged from 50% to 3% with a median maintained percentage of starting weight lost of 20%. The standard deviation of percentage of starting weight lost and maintained, which is a measure of how closely these percentages cluster around the mean was 10.5%. So most people who maintained maintained a weight loss that was between 9% and 31% of their starting weight.
This is probably the most important statistic of all as it gives you a very good idea of what a realistic weight loss is that you can expect to maintain.
People lost weight using a variety of techniques. Cutting back on carbohydrates was the most common. Thirty-eight respondents reported following some form of a Low Carb diet. Thirteen people reported using ketogenic diets--Atkins, Bernstein or under 60 grams a day of carbohydrate. However, it is possible some of the others who merely reported "low carb" diets were also eating ketogenic diets.
Fifteen respondents attributed weight loss to portion control or counting calories. Ten cited walking. Ten cited "exercise." These methods were often combined and occurred with and without carbohydrate restriction. The biggest weight loss was reported by someone who had Gastric Bypass who reports that severe health problems resulted.
Weight Regain
Twelve people reported significant weight regain. In general, the greater percentage of original body weight they had lost, the more they were likely to regain.
What really stands out is that after regaining, the weight at which these dieters who regained weight were finally able to maintain at was very close to a 20% loss from their starting weight.
This suggests very strongly that a 20% loss from starting weight is the most maintainable weight loss for most people.
Long Term Maintainers
There were 13 people who maintained their weight loss for 5 or more years. This is 25% of all people reporting and a remarkably high percentage. This result might be skewed by the self-reporting nature of this survey.
The largest percentage loss (excluding the loss from surgery) was 33% but 7 of the 10 for whom I have weight loss percentage information maintained a weight loss of 20±3 lbs of their starting weight. This is yet another bit of information that points to 20% as the ideal weight loss percentage to shoot for.
Blood Sugar Control
Five respondents out of 44 who had Type 2 reported that their blood sugar control had improved and they could tolerate more carbohydrate. One with IGT reported significant improvement.
Another 4 reported that they could tolerate slightly more carbohydrate.
Thirty-five reported no change in blood sugar control after weight loss with three stating emphatically that it did not help their blood sugar at all or that blood sugar control got worse.
However, the most important statistic relevant to blood sugar control was that all but 7 respondents reported that they continued to control their carbohydrate intake. So reported blood sugar "improvement" in most cases was dependent on continuing to eat a carbohydrate restricted diet, not because of any true change in their ability to metabolize carbohydrates.
Conclusions
These results suggest that a realistic weight loss that you can expect to maintain would be one that ranged between 10 and 30% of your starting weight, with 20% being the most likely maintainable percentage of weight loss.
They also suggest that losing weight will rarely normalize your blood sugar or "reverse" your diabetes. However, if you use a low carbohydrate diet approach of any type, you can expect to improve your blood sugar control if you continue to stick to some form of carbohydrate restriction.
Those who lost weight relying on portion control and/or exercise may also have to maintain those behaviors to retain any improvements in blood sugar control.
There is no clear cut weight loss advantage to any particular diet plan, as far as producing weight loss. Low carb diet plans appear to be somewhat easier to maintain long term if they lower carbohydrate enough to keep blood sugars controlled and avoid the hunger several people reported with higher carbohydrate weight loss diets.
People lost and maintained weight loss for several years on very low carb and moderate carb plans. Weight gain occurred on various plans too, independent of the carbohydrate intake.
----
Note: Please feel free to continue to contribute data to the poll in the previous blog post. If enough new information comes in, I will reanalyze it.
I also added an analysis of the data from those who maintained weight losses for 5+ years.
===
I've taken the information contributed by people who responded to the poll in the comments posted to the previous post and done what I could to standardize the responses in a way that makes it possible to analyze this data.
Fifty-one people contributed data. Of these 49 had Type 2, 1 had MODY and 1 had Type 1.
Two reported a weight gain.
One maintained a stable weight for 40 years but is probably not a Type 2.
Three reported no weight loss or a completely regained the weight they originally lost.
Weight Loss
Of those who lost weight and maintained some of that loss, 42 contributed information which allowed me to calculate what percentage of their starting weight they were able to lose and maintain.
The time framee people reported for their diet ranged from 40 years to just started, with a median time of 2 years.
The amount of weight loss that had been maintained ranged from 190 to 6 pounds, with a median maintained loss of 50 lbs.
The percentage of starting weight that was maintained ranged from 50% to 3% with a median maintained percentage of starting weight lost of 20%. The standard deviation of percentage of starting weight lost and maintained, which is a measure of how closely these percentages cluster around the mean was 10.5%. So most people who maintained maintained a weight loss that was between 9% and 31% of their starting weight.
This is probably the most important statistic of all as it gives you a very good idea of what a realistic weight loss is that you can expect to maintain.
People lost weight using a variety of techniques. Cutting back on carbohydrates was the most common. Thirty-eight respondents reported following some form of a Low Carb diet. Thirteen people reported using ketogenic diets--Atkins, Bernstein or under 60 grams a day of carbohydrate. However, it is possible some of the others who merely reported "low carb" diets were also eating ketogenic diets.
Fifteen respondents attributed weight loss to portion control or counting calories. Ten cited walking. Ten cited "exercise." These methods were often combined and occurred with and without carbohydrate restriction. The biggest weight loss was reported by someone who had Gastric Bypass who reports that severe health problems resulted.
Weight Regain
Twelve people reported significant weight regain. In general, the greater percentage of original body weight they had lost, the more they were likely to regain.
What really stands out is that after regaining, the weight at which these dieters who regained weight were finally able to maintain at was very close to a 20% loss from their starting weight.
This suggests very strongly that a 20% loss from starting weight is the most maintainable weight loss for most people.
Long Term Maintainers
There were 13 people who maintained their weight loss for 5 or more years. This is 25% of all people reporting and a remarkably high percentage. This result might be skewed by the self-reporting nature of this survey.
The largest percentage loss (excluding the loss from surgery) was 33% but 7 of the 10 for whom I have weight loss percentage information maintained a weight loss of 20±3 lbs of their starting weight. This is yet another bit of information that points to 20% as the ideal weight loss percentage to shoot for.
Blood Sugar Control
Five respondents out of 44 who had Type 2 reported that their blood sugar control had improved and they could tolerate more carbohydrate. One with IGT reported significant improvement.
Another 4 reported that they could tolerate slightly more carbohydrate.
Thirty-five reported no change in blood sugar control after weight loss with three stating emphatically that it did not help their blood sugar at all or that blood sugar control got worse.
However, the most important statistic relevant to blood sugar control was that all but 7 respondents reported that they continued to control their carbohydrate intake. So reported blood sugar "improvement" in most cases was dependent on continuing to eat a carbohydrate restricted diet, not because of any true change in their ability to metabolize carbohydrates.
Conclusions
These results suggest that a realistic weight loss that you can expect to maintain would be one that ranged between 10 and 30% of your starting weight, with 20% being the most likely maintainable percentage of weight loss.
They also suggest that losing weight will rarely normalize your blood sugar or "reverse" your diabetes. However, if you use a low carbohydrate diet approach of any type, you can expect to improve your blood sugar control if you continue to stick to some form of carbohydrate restriction.
Those who lost weight relying on portion control and/or exercise may also have to maintain those behaviors to retain any improvements in blood sugar control.
There is no clear cut weight loss advantage to any particular diet plan, as far as producing weight loss. Low carb diet plans appear to be somewhat easier to maintain long term if they lower carbohydrate enough to keep blood sugars controlled and avoid the hunger several people reported with higher carbohydrate weight loss diets.
People lost and maintained weight loss for several years on very low carb and moderate carb plans. Weight gain occurred on various plans too, independent of the carbohydrate intake.
----
Note: Please feel free to continue to contribute data to the poll in the previous blog post. If enough new information comes in, I will reanalyze it.
February 11, 2009
Please Participate: Poll About Diabetes and Weight Loss
Satisfy my curiosity by answering the following questions by replying in a comment:
1. Did you lose weight intentionally after your diabetes diagnosis?
2. How much did you lose? What percentage of your starting weight was this?
3. How did you lose it?
4. Did you keep the weight off 1 and 5 years after you lost it?
5. Did the weight loss make a difference in your blood sugars in terms of changing how much carbohydrate you could eat without spikes?
1. Did you lose weight intentionally after your diabetes diagnosis?
2. How much did you lose? What percentage of your starting weight was this?
3. How did you lose it?
4. Did you keep the weight off 1 and 5 years after you lost it?
5. Did the weight loss make a difference in your blood sugars in terms of changing how much carbohydrate you could eat without spikes?
February 7, 2009
Another Reason Why Diabetes Causes Obesity?
A study described in today's edition of Science Daily may point to yet another reason, besides the raging hunger caused by high post-meal blood sugar surges, that obesity is not the cause of diabetes but is caused by the blood sugar abnormalities which characterize the early stages of blood sugar dysfunction.
Here's the report: Researchers Shed Light On Fat Burning
It's a rodent study, which means that we can't be sure that the finding will hold up when applied to humans. But what the researchers discovered has the feel of basic physiology--the kind of thing that may apply across species.
What they found was this: "... during the process of burning fat — called lipolysis — fat cells use sensory nerves to feed information to the brain."
Furthermore, Science News reports,
So if it is true that the thermostat that regulates how much fat we burn and how much we store depends on tiny nerve cells that reach into our fat, destruction of those tiny nerve cells early on in the deteriorative process could go a long way towards explaining why people who are experiencing "prediabetic" blood sugars--including those who do not go on to develop full-fledged diabetes--get fat.
That this may be true is suggested by another finding about the function of tiny nerve cells in an unexpected context: one that did test out in human beings. Dr. Kevin Tracey's work has established that the inflammatory response mounted by the immune system is regulated by the brain in response to signals it receives from the vagus nerve.
The vagus nerve it the major nerve pathway of the autonomic nervous system and as it branches out, it looks very much like an upside down tree that extends throughout our bodies until it terminates in tiny nerve fibers that reach all our cells.
If these nerve endings are crippled by neuropathy, the body does not sense invasion properly and may not mount an effective counterattack against infection. This may have a lot to do with why people who have developed neuropathy are so prone to getting infections that won't heal.
This new research points to yet another way that the nerves and brain may communicate to regulate the vital functions that sustain life.
We'll have to keep alert to learn if there is more followup to this research. Unfortunately, breakthroughs in basic science such as this one don't get the press that trivial news about the latest overhyped drugs receive.
Meanwhile, this is yet another factor that should motivate people with prediabetes to rein in their post-meal blood sugars. We know without the slightest doubt that blood sugars that rise over 140 mg/dl for more than an hour or so damage small nerve fibers. This has been confirmed by several independent studies. Keeping your blood sugar under 140 mg/dl as much as possible also appears, based on anecdotal evidence, to slowly reverse neuropathy over a period of several years.
To learn how to lower your blood sugar, visit this page:
How to Get Your Blood Sugar Under Control
Here's the report: Researchers Shed Light On Fat Burning
It's a rodent study, which means that we can't be sure that the finding will hold up when applied to humans. But what the researchers discovered has the feel of basic physiology--the kind of thing that may apply across species.
What they found was this: "... during the process of burning fat — called lipolysis — fat cells use sensory nerves to feed information to the brain."
Furthermore, Science News reports,
they found that the brain uses part of the nervous system used to regulate body functions, called the sympathetic nervous system, to in turn communicate back to the cells to initiate, continue or stop the fat burning depending upon the information the brain receives from the fat.Why did this set off alarm bells when I read it? Because small fiber sensory nerves are the very first nerves to be damaged by high blood sugars--blood sugars in the so-called "prediabetic" range. You can read about the research studies that documented this finding HERE.
"The brain can trigger lipid burning by fat cells and through these sensory nerves, the fat cell can give the brain feedback," Bartness explained. "This is a really important concept in biology, as it can regulate the process of lipolysis much like how a thermostat regulates temperature in your house, using input from the air and output to a furnace or heating unit.
So if it is true that the thermostat that regulates how much fat we burn and how much we store depends on tiny nerve cells that reach into our fat, destruction of those tiny nerve cells early on in the deteriorative process could go a long way towards explaining why people who are experiencing "prediabetic" blood sugars--including those who do not go on to develop full-fledged diabetes--get fat.
That this may be true is suggested by another finding about the function of tiny nerve cells in an unexpected context: one that did test out in human beings. Dr. Kevin Tracey's work has established that the inflammatory response mounted by the immune system is regulated by the brain in response to signals it receives from the vagus nerve.
The vagus nerve it the major nerve pathway of the autonomic nervous system and as it branches out, it looks very much like an upside down tree that extends throughout our bodies until it terminates in tiny nerve fibers that reach all our cells.
If these nerve endings are crippled by neuropathy, the body does not sense invasion properly and may not mount an effective counterattack against infection. This may have a lot to do with why people who have developed neuropathy are so prone to getting infections that won't heal.
This new research points to yet another way that the nerves and brain may communicate to regulate the vital functions that sustain life.
We'll have to keep alert to learn if there is more followup to this research. Unfortunately, breakthroughs in basic science such as this one don't get the press that trivial news about the latest overhyped drugs receive.
Meanwhile, this is yet another factor that should motivate people with prediabetes to rein in their post-meal blood sugars. We know without the slightest doubt that blood sugars that rise over 140 mg/dl for more than an hour or so damage small nerve fibers. This has been confirmed by several independent studies. Keeping your blood sugar under 140 mg/dl as much as possible also appears, based on anecdotal evidence, to slowly reverse neuropathy over a period of several years.
To learn how to lower your blood sugar, visit this page:
How to Get Your Blood Sugar Under Control
February 2, 2009
Why Doctors are Telling Type 2s Not to Lower Blood Sugar--And Why They Are Wrong
Doctors who get all their diabetes "education" from newsletters that summarize recent research in oversimplified sound bites have misinterpreted two recent studies in a way that is starting to hurt people.
I know this because I am starting to get email from people with Type 2 whose doctors have warned them that it is useless and possibly dangerous to lower blood sugars and even, occasionally told them to raise their blood sugars.
These are Type 2s who are not using insulin. Occasionally a Type 1 who achieves a 5% A1c may be flirting with danger because they are achieving that A1c by spending a lot of time hypo. But this is not the case here. These people are controlling with diet.
My guess is that this latest rash of terrible medical advice is the result of doctors adding a garbled version of the findings of a new study to their earlier misinterpretation of the highly questionable ACCORD study --a study I discussed in detail HERE, HERE, and HERE
The new study was published in December in the prestigious New England Journal of Medicine and was a five year long study of 1791 military veteran performed at VA hospitals.
It concluded that for this group of veterans, lowering blood sugar "had no significant effect on the rates of major cardiovascular events, death, or microvascular complications." Because the group who lowered their blood sugar here--defined as achieving an A1c of 6.9% had a high rate of hypos, the conclusion seems to be that lowering blood sugar even to the ADA 7.0% target is a dangerous waste of time for people with Type 2.
Here's the link to the study:
Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes William Duckworth, et al.
This study needs to be looked at very carefully, because its results contradict the results of every other large study that has ever been done with people with Type 2 diabetes, including UKPDS, UKPDS-followup, ACCORD and ADVANCE, all of which found significant improvements in microvascular complications as A1c dropped below 7.0%.
Though the amount of cardiovascular improvement varies from study to study in all these earlier studies, most found some improvement, and only one study, ACCORD, found a tiny rise in heart attack incidence in the group with lower blood sugar, a finding that was not confirmed by ADVANCE, a larger, longer study that used the same blood sugar target but did not lower blood sugars using the same promiscuous mixing of side-effect-rich diabetes drugs.
Most importantly, ALL these studies found that lowering A1c lowered the rate of microvascular complications--neuropathy and its resultant amputation, retinopathy, and kidney failure.
I do not have full text access to this latest New England Journal of Medicine article, but here is what the abstract reports:
I do not question that they found what they say they found. In this group of veterans, whose average age was 60, there was no difference at all between those who had a 8.4% A1c and those with the 6.9% A1c except that one in four of the latter group experienced significant hypos.
But I do demand a bit more explanation about WHY this was the case, and I am disgusted with the editors for not demanding that this be included in the abstract of the study.
As it wasn't, I can only guess what the explanation might be, but these guesses are worth consideration.
A couple points stand out here. The abstract states that 40% of these veterans had already had a heart attack. That suggests to me that they were in much poorer shape than the average person with diabetes. This probably has a lot to do with their outcome.
But I am well aware that the level of care at many veterans hospitals has become very poor, with patients having to wait weeks and months for clinic appointments, and with doctor shortages meaning that these hospitals are often staffed by graduates of foreign medical schools whose training in diabetes may be very poor who do not speak English very well.
Because of this, people with good health insurance who live in more affluent neighborhoods with community hospitals and a choice of doctors avoid them. So the VA hospitals are used primarily by poor and minority veterans. This may be why their health by the time they are 60 years old is so bad: It is what you would expect of people who have had poor access to health care, healthy food, education, safe jobs, clean air, water and safe neighborhoods where you can take a walk in the evening --things that are taken for granted by more affluent Americans.
So right away, I wonder if what we are seeing in this study is not that lowering blood sugar is ineffective in Type 2 diabetes, but that in people who live in polluted neighborhoods, who work dangerous jobs that expose them to poisonous chemicals, and end up living with undiagnosed by highly abnormal blood sugar for 30 years while received almost no medical care, to the point where almost half of them have had heart attacks at a relatively young age, lowering blood sugar is not enough to undo the damage already done.
This is a very different conclusion.
We know that Black people living in inner cities in the U.S. have a far higher rate of amputation than more affluent people. We also know that amputation is completely avoidable when people have access to doctors who are educated in how to treat diabetes and when patients are taught how to use a blood sugar meter, adjust their carbohydrate intake down to a tolerable level, and inject insulin using a basal/bolus regimen.
Black people in inner cities don't get that kind of care. Just as so many Black people had to wait of 8 to 12 hours to vote because their precincts could not afford to buy enough voting machines, while affluent suburbanites could zip into the polls, vote and go home, access to health care is very different in the U.S., depending on where you live and how wealthy you are.
But whatever the explanation for the findings of this study. Too much data has accumulated to take its results at face value. Clearly, something was very wrong here and the researchers owed it to the medical community to explain why their subjects' outcomes were so completely at odds with that experienced by every other population of people with Type 2 ever studied.
If your doctor draws any other conclusion from this study, find a new doctor. We have almost 20 years of data now that support the finding that lowering blood sugars makes a dramatic difference in whether or not people experience microvascular complications and that the lower the blood sugar the lower the incidence of microvascular complications. Even ACCORD found this to be true!
The only remaining debate is whether lowering blood sugars can have any impact on established heart disease and the answer to that question has not yet been settled.
Any doctor who tells you otherwise and urges you to worsen your control is a danger to your health. Don't debate such a doctor. Fire him. It's that simple.
NOTE: Check out the comments, you'll learn more about what was in the full text of this article. When I get more time I'll update this information too, as several people have sent me the full text version.
I know this because I am starting to get email from people with Type 2 whose doctors have warned them that it is useless and possibly dangerous to lower blood sugars and even, occasionally told them to raise their blood sugars.
These are Type 2s who are not using insulin. Occasionally a Type 1 who achieves a 5% A1c may be flirting with danger because they are achieving that A1c by spending a lot of time hypo. But this is not the case here. These people are controlling with diet.
My guess is that this latest rash of terrible medical advice is the result of doctors adding a garbled version of the findings of a new study to their earlier misinterpretation of the highly questionable ACCORD study --a study I discussed in detail HERE, HERE, and HERE
The new study was published in December in the prestigious New England Journal of Medicine and was a five year long study of 1791 military veteran performed at VA hospitals.
It concluded that for this group of veterans, lowering blood sugar "had no significant effect on the rates of major cardiovascular events, death, or microvascular complications." Because the group who lowered their blood sugar here--defined as achieving an A1c of 6.9% had a high rate of hypos, the conclusion seems to be that lowering blood sugar even to the ADA 7.0% target is a dangerous waste of time for people with Type 2.
Here's the link to the study:
Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes William Duckworth, et al.
This study needs to be looked at very carefully, because its results contradict the results of every other large study that has ever been done with people with Type 2 diabetes, including UKPDS, UKPDS-followup, ACCORD and ADVANCE, all of which found significant improvements in microvascular complications as A1c dropped below 7.0%.
Though the amount of cardiovascular improvement varies from study to study in all these earlier studies, most found some improvement, and only one study, ACCORD, found a tiny rise in heart attack incidence in the group with lower blood sugar, a finding that was not confirmed by ADVANCE, a larger, longer study that used the same blood sugar target but did not lower blood sugars using the same promiscuous mixing of side-effect-rich diabetes drugs.
Most importantly, ALL these studies found that lowering A1c lowered the rate of microvascular complications--neuropathy and its resultant amputation, retinopathy, and kidney failure.
I do not have full text access to this latest New England Journal of Medicine article, but here is what the abstract reports:
Median glycated hemoglobin levels were 8.4% in the standard-therapy group and 6.9% in the intensive-therapy group. The primary outcome occurred in 264 patients in the standard-therapy group and 235 patients in the intensive-therapy group. There was no significant difference between the two groups in any component of the primary outcome or in the rate of death from any cause. No differences between the two groups were observed for microvascular complications. The rates of adverse events, predominantly hypoglycemia, were 17.6% in the standard-therapy group and 24.1% in the intensive-therapy group.
I do not question that they found what they say they found. In this group of veterans, whose average age was 60, there was no difference at all between those who had a 8.4% A1c and those with the 6.9% A1c except that one in four of the latter group experienced significant hypos.
But I do demand a bit more explanation about WHY this was the case, and I am disgusted with the editors for not demanding that this be included in the abstract of the study.
As it wasn't, I can only guess what the explanation might be, but these guesses are worth consideration.
A couple points stand out here. The abstract states that 40% of these veterans had already had a heart attack. That suggests to me that they were in much poorer shape than the average person with diabetes. This probably has a lot to do with their outcome.
But I am well aware that the level of care at many veterans hospitals has become very poor, with patients having to wait weeks and months for clinic appointments, and with doctor shortages meaning that these hospitals are often staffed by graduates of foreign medical schools whose training in diabetes may be very poor who do not speak English very well.
Because of this, people with good health insurance who live in more affluent neighborhoods with community hospitals and a choice of doctors avoid them. So the VA hospitals are used primarily by poor and minority veterans. This may be why their health by the time they are 60 years old is so bad: It is what you would expect of people who have had poor access to health care, healthy food, education, safe jobs, clean air, water and safe neighborhoods where you can take a walk in the evening --things that are taken for granted by more affluent Americans.
So right away, I wonder if what we are seeing in this study is not that lowering blood sugar is ineffective in Type 2 diabetes, but that in people who live in polluted neighborhoods, who work dangerous jobs that expose them to poisonous chemicals, and end up living with undiagnosed by highly abnormal blood sugar for 30 years while received almost no medical care, to the point where almost half of them have had heart attacks at a relatively young age, lowering blood sugar is not enough to undo the damage already done.
This is a very different conclusion.
We know that Black people living in inner cities in the U.S. have a far higher rate of amputation than more affluent people. We also know that amputation is completely avoidable when people have access to doctors who are educated in how to treat diabetes and when patients are taught how to use a blood sugar meter, adjust their carbohydrate intake down to a tolerable level, and inject insulin using a basal/bolus regimen.
Black people in inner cities don't get that kind of care. Just as so many Black people had to wait of 8 to 12 hours to vote because their precincts could not afford to buy enough voting machines, while affluent suburbanites could zip into the polls, vote and go home, access to health care is very different in the U.S., depending on where you live and how wealthy you are.
But whatever the explanation for the findings of this study. Too much data has accumulated to take its results at face value. Clearly, something was very wrong here and the researchers owed it to the medical community to explain why their subjects' outcomes were so completely at odds with that experienced by every other population of people with Type 2 ever studied.
If your doctor draws any other conclusion from this study, find a new doctor. We have almost 20 years of data now that support the finding that lowering blood sugars makes a dramatic difference in whether or not people experience microvascular complications and that the lower the blood sugar the lower the incidence of microvascular complications. Even ACCORD found this to be true!
The only remaining debate is whether lowering blood sugars can have any impact on established heart disease and the answer to that question has not yet been settled.
Any doctor who tells you otherwise and urges you to worsen your control is a danger to your health. Don't debate such a doctor. Fire him. It's that simple.
NOTE: Check out the comments, you'll learn more about what was in the full text of this article. When I get more time I'll update this information too, as several people have sent me the full text version.
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