January 12, 2011 -- BOSTON—New studies are prompting doctors to re-examine a fundamental treatment question: what level of blood sugar is best? The debate has focused on the level at which people with type 2 diabetes should try to maintain their blood sugar. Randomized trials haven’t completely answered the question, reports the January 2011 issue of Harvard Men’s Health Watch, but they offer some direction. Here’s what some recent major studies found:
- The ACCORD study was halted early, after three-and-a-half years, because the death rate had increased among the participants receiving treatments aimed at intensive control of blood sugar.
- Another study found that five years of tight blood sugar control provided protection against complications of diabetes involving small blood vessels (including damage to the kidneys, nerves, or eyes) but not against heart attack or stroke.
- A study of veterans found that after more than five years, rates of complications and death were the same in those assigned to tight blood sugar control and those assigned to standard control.
- A British study found that participants with moderate blood sugar control experienced fewer cardiovascular problems and were less likely to have died during the trial than those with strict control or minimal control.
Harvard Men’s Health Watch notes that these trials and other research have modified some assumptions about the treatment of diabetes. Still, some principles seem clear:
- Diet, exercise, and weight control should be the cornerstone of management for all diabetics.
- Good blood sugar control is important. In people with type 1 diabetes, tight control reduces the risk of many types of complications.
- People who take insulin should monitor their own blood sugar levels. They should also learn to recognize symptoms of low blood sugar (hypoglycemia), know how to quickly boost their blood sugar if it falls too low, and know how to get help in an emergency.
- Blood sugar goals should be adjusted according to the needs of the individual. The main measure used is hemoglobin A1C (HbA1C), a blood test that estimates average blood sugar levels over the preceding month. In people with type 2 diabetes, an HbA1C target of 7.0% to 7.5%, which corresponds to an average blood sugar level of about 150 to 170 mg/dL, seems to be reasonable.
Read the full-length article: “Controlling blood sugar in diabetes: How low should you go?”
Also in this issue:
- Recovering erectile function after prostate cancer surgery
- Treating the bent fingers of Dupuytren’s contracture
- Lifestyle and pancreatic cancer risk
Harvard Men’s Health Watch is available from Harvard Health Publications (www.health.harvard.edu), the publishing division of Harvard Medical School, for $28 per year. Subscribe at www.health.harvard.edu/men or by calling 877-649-9457 (toll-free).
Media: Contact Raquel Schott at Raquel_Schott@hms.harvard.edu for a complimentary copy of the newsletter, or to receive our press releases directly.
