1. Get the Diabetes Forum App for your phone - available on iOS and Android.
    Dismiss Notice
  2. Guest, we'd love to know what you think about the forum! Take the Diabetes Forum Survey 2021 »
    Dismiss Notice
  3. Diabetes Forum should not be used in an emergency and does not replace your healthcare professional relationship. Posts can be seen by the public.
    Dismiss Notice
  4. Guest, stay home, stay safe, save the NHS. Stay up to date with information about keeping yourself and people around you safe here and GOV.UK: Coronavirus (COVID-19). Think you have symptoms? NHS 111 service is available here.
    Dismiss Notice
Dismiss Notice
Find support, ask questions and share your experiences. Join the community »

An Alternative Perspective on Diabetes Management

Discussion in 'Diabetes Research' started by AdamJames, Dec 11, 2017.

  1. AdamJames

    AdamJames Type 2 · Well-Known Member

    Messages:
    1,338
    Likes Received:
    870
    Trophy Points:
    153
    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.
     
  2. woodywhippet61

    woodywhippet61 Type 2 · Well-Known Member

    Messages:
    489
    Likes Received:
    321
    Trophy Points:
    103
    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.
     
    #2 woodywhippet61, Dec 11, 2017 at 7:46 AM
    Last edited: Dec 11, 2017
  3. bulkbiker

    bulkbiker Type 2 · Oracle

    Messages:
    18,399
    Likes Received:
    12,248
    Trophy Points:
    298
    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?
     
    • Agree Agree x 2
    • Like Like x 1
    • Winner Winner x 1
    • Informative Informative x 1
  4. Dark Horse

    Dark Horse · Well-Known Member

    Messages:
    1,715
    Likes Received:
    941
    Trophy Points:
    133
    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.
     
    • Informative Informative x 1
  5. Pinkorchid

    Pinkorchid Type 2 · Well-Known Member

    Messages:
    2,918
    Likes Received:
    1,957
    Trophy Points:
    198
    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.
     
  6. urbanracer

    urbanracer Type 1 · Expert
    Retired Moderator

    Messages:
    5,027
    Likes Received:
    3,646
    Trophy Points:
    198
    "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.
     
    • Agree Agree x 1
  7. AdamJames

    AdamJames Type 2 · Well-Known Member

    Messages:
    1,338
    Likes Received:
    870
    Trophy Points:
    153
    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.
     
    • Winner Winner x 1
  8. covknit

    covknit Prefer not to say · Well-Known Member

    Messages:
    467
    Likes Received:
    357
    Trophy Points:
    103
    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.
     
    • Optimistic Optimistic x 1
  • Meet the Community

    Find support, connect with others, ask questions and share your experiences with people with diabetes, their carers and family.

    Did you know: 7 out of 10 people improve their understanding of diabetes within 6 months of being a Diabetes Forum member. Get the Diabetes Forum App and stay connected on iOS and Android

    Grab the app!
  • Tweet with us

  • Like us on Facebook