Is Moderate Control of Diabetes Better?
By: Charlotte Ames
Updated: April 27, 2010
Diabetics have to keep a close eye on their blood sugar, many opting to keep their levels as low as they possibly can. But a new study supports the idea of moderation.
Many people with type 2 diabetes can control their disease by losing weight, exercising, eating a healthy diet and taking medication that improves the body’s ability to use insulin. Previous research has suggested that maintaining tight control over blood glucose levels (keeping them as close to the “normal” range as much as possible) can reduce the risk for many complications associated with diabetes.
The traditional finger prick test for blood sugar only provides an indication of glucose levels at that point in time. To get an idea of how glucose levels may have fluctuated over time, doctors recommend another blood test, called the HbA1c. When blood sugar levels are high, some of the glucose binds with the hemoglobin in the red blood cells (called glycated hemoglobin). The HbA1c test (often referred to as A1c) measures the percentage of glycated hemoglobin in the blood over the past 120 days (roughly the lifespan of a red blood cell).
Health experts currently recommend that patients aim for A1c levels of less than 7 percent. In fact, the CDC reports dropping A1c just one percent, from 8 percent to 7 percent, reduces the risk for eye, kidney and nerve disease complications by 40 percent.
Several studies over the past few years are now questioning the value of keeping too tight control over A1c levels (i.e., below 7 percent). The latest study, published in the journal, The Lancet in February 2010, reports that a median A1c level of 6.4 percent was associated with a significantly higher risk of heart attack and death from all causes. Mortality rates were highest among aggressively managed patients taking insulin.
Matt Davies, M.D., Ph.D., Endocrinologist with the Swedish Medical Center in Seattle, WA, says the findings still show that keeping A1c levels around or just above 7 percent is still beneficial. However, he believes treatment goals should be individualized, allowing doctors to consider a patient’s medical history and treatment plan before setting a target A1c goal.
Many people with type 2 diabetes can control their disease by losing weight, exercising, eating a healthy diet and taking medication that improves the body’s ability to use insulin. Previous research has suggested that maintaining tight control over blood glucose levels (keeping them as close to the “normal” range as much as possible) can reduce the risk for many complications associated with diabetes.
The traditional finger prick test for blood sugar only provides an indication of glucose levels at that point in time. To get an idea of how glucose levels may have fluctuated over time, doctors recommend another blood test, called the HbA1c. When blood sugar levels are high, some of the glucose binds with the hemoglobin in the red blood cells (called glycated hemoglobin). The HbA1c test (often referred to as A1c) measures the percentage of glycated hemoglobin in the blood over the past 120 days (roughly the lifespan of a red blood cell).
Health experts currently recommend that patients aim for A1c levels of less than 7 percent. In fact, the CDC reports dropping A1c just one percent, from 8 percent to 7 percent, reduces the risk for eye, kidney and nerve disease complications by 40 percent.
Several studies over the past few years are now questioning the value of keeping too tight control over A1c levels (i.e., below 7 percent). The latest study, published in the journal, The Lancet in February 2010, reports that a median A1c level of 6.4 percent was associated with a significantly higher risk of heart attack and death from all causes. Mortality rates were highest among aggressively managed patients taking insulin.
Matt Davies, M.D., Ph.D., Endocrinologist with the Swedish Medical Center in Seattle, WA, says the findings still show that keeping A1c levels around or just above 7 percent is still beneficial. However, he believes treatment goals should be individualized, allowing doctors to consider a patient’s medical history and treatment plan before setting a target A1c goal.
