Why would the NHS want to recommend having levels higher than the average for someone who doesn't have diabetes; seems pretty illogical to me.
Why would the NHS want to recommend having levels higher than the average for someone who doesn't have diabetes; seems pretty illogical to me.
Unfortunately many people with T1 who have much lower HbA1c levels also have a loss of hypo glycaemic awareness and are at risk of serious and sometimes life threatening hypos.
I now think that this pessimistic view may not be giving a full picture for. T2. The results of bariatric surgery, the Newcastle Trials (see Prof Taylor's twin Cycle paper) and magnetic imaging is beginning to show a different more hopeful picture ie that beta cell function once thought of as 'dead' and unrecoverable maybe not so dead. (indeed even some T1 research has shown regeneration of islet cells)
There are papers that report CVD at quite low HbA1c levels but on the other side there are also those that show a U or J shaped curve with those with lower levels being more likely to die than those with slightly higher levels.
Many of these people may have beenquite sick and taking large amounts of medications (for diabetes and other conditions) , in these cases striving for very low post prandial (or any other time of day) levels may be counterproductive.
As far as I know, you aren't sick with other things It might be a different matter if you are already suffering from serious co-morbidities.
Yes you are right ACCORD. It is interesting that the PLOS ONE article seems to restate the discredited ACCORD position. I really find it counter intuitive that aiming to have a low hBA1c i.e.. a non diabetic persons hBA1c increases risks. Surely if higher hBA1c's were better then people would have evolved to mostly have that higher range as that would be more successful in evolutionary terms.
The Hunt 2 study found a similar relationship with cholesterol in men i.e below about a total count of 5.5 and your risks begin to increase.
I suppose everyone should make their own judgement. In my case I'll continue to believe having an hBA1c at roughly the evolutionary average is best.
However, most patients on diabetes medication will also be offered dietary advice, making difficult any definite distinction about differential reduction in HbA1c levels between diet and medication in observational studies.
It is likely that mortality risks may differ for different drugs and drug combinations and several studies [34], [35] have linked sulphonylurea drugs with increased mortality and glitazone therapy with increased risk of cardiovascular events [36], [37]. These are important hypotheses that deserve to be evaluated as primary hypotheses of interest in purposely designed studies, rather than as secondary analyses in studies implemented for other purposes such as the present study.
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0068008
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