An Alternative Perspective on Diabetes Management

[AdamJames]

I can't see this mentioned on this forum when I do a search so though I'd link to it and see what other people think.

As an overweight Type 2 who has been preoccupied for months primarily with blood glucose control, secondly with trying to avoid needing medication, and thirdly with losing weight, I was surprised when I stumbled across a site which suggests that really, when you look at the bigger picture and actual outcomes for overweight people with Type 2, glucose control isn't necessarily the first thing to be focusing on, and metformin shouldn't be seen as something to try to avoid.

It's quite a refreshing read, regardless of what you think of it, and I'd be interested in people's opinions.

http://www.aafp.org/afp/2014/0215/p256.html

Don't miss the "related letter" link near the top, in which they defend their stance rather well I thought, though I think they should have made it much more clear in their main article that they are focusing particularly on *overweight* people with type 2, presumably people so overweight that other factors become significant in terms of overall health outlook.

 

[woodywhippet61]

Really useful for me then. My blood pressure is,normal. I don't smoke. Cholesterol levels not a problem and with my history of IBS Metformin use is not advised. So I'm going to die earlier as I have lowered my BGL's.

I understood that the early death due to lowering bgl's happened when people were on meds NOT people who had done it from diet. I'm sure that someone will correct me if I've got this wrong.

 

[bulkbiker]

I personally think their logic is rather flawed.

By reducing blood glucose using an ultra low carb way of eating and intermittent fasting.
I have reduced my blood pressure (had already given up smoking 8 years pre diagnosis)
Gave up metformin as it caused me many problems (yes both types)
I disagree with what they say about cholesterol anyway
Have achieved HbA1c results at the lower end of "normal"
Lost a shed load of weight in the process.

Their fears of good control are presumably based on over-medication to bring bloods down rather than dietary methods.
Why would I wish to take a drug (which will have some side effects whatever it is) when I can do all of the above without it?

 

[Dark Horse]

I can't see this mentioned on this forum when I do a search so though I'd link to it and see what other people think.

As an overweight Type 2 who has been preoccupied for months primarily with blood glucose control, secondly with trying to avoid needing medication, and thirdly with losing weight, I was surprised when I stumbled across a site which suggests that really, when you look at the bigger picture and actual outcomes for overweight people with Type 2, glucose control isn't necessarily the first thing to be focusing on, and metformin shouldn't be seen as something to try to avoid.

It's quite a refreshing read, regardless of what you think of it, and I'd be interested in people's opinions.

http://www.aafp.org/afp/2014/0215/p256.html

Don't miss the "related letter" link near the top, in which they defend their stance rather well I thought, though I think they should have made it much more clear in their main article that they are focusing particularly on *overweight* people with type 2, presumably people so overweight that other factors become significant in terms of overall health outlook.

Very interesting article and letter(s), thank you. I seem to remember one poster on the forum tried to raise the subject of the relative importance of blood glucose control versus smoking cessation but it seemed to be taken as a personal criticism by people who smoked and I'm not sure there was any meaningful discussion. Although the article seems to be focusing on macrovascular complication,s e.g. heart attack and stroke, it is true that high blood pressure and lipids are risk factors for microvascular complications, e.g. the progression of diabetic retinopathy, although I don't see this being discussed much on the forum.

I would point out that the authors are discussing 'aggressive glycaemic control' which involves the use of drug therapy in addition to metformin. They don't seem to have commented on diet-controlled blood glucose.

 

[Pinkorchid]

Isn't what was said much of what we do already..... ie loose weight, stop smoking, control our cholesterol and blood pressure and many of us take Meformin so what's new.

 

[urbanracer]

"Physicians should not let well-intentioned but misguided concern for glucose levels distract them from attending to other interventions that more profoundly affect mortality: smoking cessation, blood pressure control, metformin therapy, and lipid reduction."

It seems to me that the article is aimed at patients with other life threatening conditions. I don't really see the relevance to diabetics who are otherwise healthy. If I was a T2 it wouldn't be enough to convince me to relax my BG control.

 

[AdamJames]

Interesting opinions here, thanks.

It's certainly a minefield that needs to be waded through carefully in order for each of us to get a feel what is best for us as an individual, and of course any course of action will be a bit of a gamble.

I think the main article's main failing is its lack of making it clear exactly what type of patient they are thinking of. I have a (perhaps unfair) suspicion that they were deliberately trying to be a bit iconoclastic.

By contrast, the letter and rebuttal linked to at the top of the article are far better at making their thoughts and reasoning clear and is really more informative.

I think their effort to separate what's "important" and what's not, based purely on the health and happiness of the patients, certainly has merit. E.g. in their letter rebuttal, they have the attitude "so what if lack of bg control causes issues with eyes - all that's really important is vision loss, and that doesn't seem to be affected".

Whether or not their analysis is *correct* is another matter, but the *focus* I find appealing.

Anyway my personal takeaway from it is that I'm glad I'm losing weight rapidly and will continue to do so, as that can only be a good thing, not just for diabetes but for all sorts of reasons. There's no way I'm going to take my eye of blood sugar levels, but there is a bigger picture, and it's the usual one: try to be active, a healthy weight, eat sensibly and enjoy life.

 

[covknit]

Cut and paste
......
our primary concern is the significant increase in mortality associated with insulin therapy once the A1C falls below 7.5%.4 We are disappointed that national organizations still recommend pharmaceutically lowering blood glucose levels despite evidence that fails to show benefit and instead demonstrates potential harm.

The reason we based our model on a hand is that regardless of whether aggressive glycemic reduction is beneficial in overweight patients with type 2 diabetes—and the best evidence strongly suggests that it is not—clinicians must spend their time with patients focusing on the other life-prolonging “fingers” of diabetes care. Poor control of hypertension is associated with high blood glucose levels, meaning that clinicians spend too much time on the “pinky” of glycemic control and not enough time on blood pressure control.6

Let's stop reversing the hand and start saving lives.

Interesting. Food for thought for everyone needing to balance the needs of multiple conditions, especially when references are shown to be comparing results from studies including the Japanese BMI >19 to the >25 targeted in the article. Since most of my meds clearly state they increase BG it is good to know this. There again I do take 47 doses of my various, each and every day so it could potentially have a significant cumilative effect. Thank you for the link.