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Message: <blockquote data-quote="phoenix" data-source="post: 216389" data-attributes="member: 12578">Possibly your doc is looking at recent trials: Results from 2 recent trials ,the ACCORD trial  and a piece of research from Cardiff University in UK  found that groups of people  with the lowest HbA1cs had  higher  mortality rates  than those with moderately high HbA1cs around  7% . We've discussed these trials before (search  Cardiff and ACCORD)  I think a lot of people think that one of the most important considerations is how you achieve the  lower HbA1c.    In the Accord trial, results showed that patients with cardiovascular disease or at least two risk factors for cardiovascular disease or severe atherosclerosis, and an HbA1c of 7·5% who were then given medications to reduce their levels to  around 6%  had increased mortality . It may be the methods that were used to achieve this  lower HbA1c that caused the problem:      ie too much medication in order to achieve low levels . These people already had problems with CVD.<a href="http://www.diabetesincontrol.com/articles/diabetes-news/10614-tight-control-in-advanced-diabetes-still-risky" target="_blank">http://www.diabetesincontrol.com/articl ... till-risky</a>In the Cardifff study they examined a large set of patients notes and analysed them. so this was what had happened in a non controlled setting and as such depends to a certain extent to the quality of the data (ie how well the GPS keep their records)  These are 2 of the  graphs  from the paper.  The  graphs show    the hazard  ratios ie the risks of mortality, the least risky place is at the bottom of the curve. The first is  for those on a combination of metformin and sulfonylureas, the second for those  who  had changed their medications to include insulin: In the UK  of course .. particularly in the past (and this study was looking at patients from 1986-2008) insulin was very much a 'last resort'  It may not be the insulin so much as patients histories of poor control  before going onto insulin. Many  of those in the insulin group were  in fact taking  both oral medications and insulin .(so this isn't applicable to T1).  Some reports suggest it may be hypos or low blood glucose levels causing heart problems  that  were the problem but that is only an hypothesis there is  actually no evidence.The cause of death was not  acually included in the Cardiff study.( Earlier reports suggested hypos is the    ACCORD trial but it was later  found  that this wasn't the case)<a href="http://www.endocrinetoday.com/view.aspx?rid=60440" target="_blank">http://www.endocrinetoday.com/view.aspx?rid=60440</a>Cardiff study original paper.<a href="http://bioestadistica.fib.upc.edu/bioestadistica/public/img/Image/Exemples/Survival%20as%20a%20function%20of%20HbA1c%20in%20people%20with%20type%202%20diabetes%20a%20retrospective%20cohort%20study.pdf" target="_blank">http://bioestadistica.fib.upc.edu/bioes ... 0study.pdf</a> I think (personal opinion and I'm neither a doc nor T2 so I have to take insulin)  that these studies don't   have't much  to do with people who are using diet and exercise or just metformin. So if you can get low results using gthese methods fine.  I also think that the  Cardiff study is  perhaps less applicable to  younger people (the average age at baseline was in the 60s)  . However it might very well  be that using lots of drugs for  people  who have difficulties maintaining a low HbA1c is counterproductive.</blockquote>

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