I wonder what you make of this...

a bit more detail
http://www.medicalnewstoday.com/articles/177199.php

Well I'm interested that you automatically associate low-carbing with low HbA1c's. That is of course a proper association to have in one's mind, but I don't see where this report mentions low-carbing at all?

What it talks about is "intensive treatment to control blood glucose" which sounds like increased medication to me, which is the same as was found in the ACCORD study. So, how can we reduce medication and still get low HBA1c's? I'm racking my brain here. Oh, yes; by low-carbing.

I haven't posted here for some time, but pleased to see it's the same old fun and japes...

>>Data suggest that insulin could increase the risk of death in type 2 diabetes. <<

this is a quote from he article cited by Phoenix
I've seen studies like this before. they don't separate out the patients using diet control from the ones using multiple toxic medication.
In fact it's a scientific nonsense. Why should a low HbA1c in itself be dangerous? After all non-diabetics have Hba1cs in the range 3.5% to about 6% with an average around 5%. If it's that alone, then non-diabetics should be dropping like flies.
If you want to design a study properly, you isolate the variables and apply a bit of logic..
I have long had the suspicion that " eat what you like and take some more insulin to cover it, is a dangerous philosophy.
all medication has side effects.
That's what this study is actually showing. I'd like to write to the people who did it and ask if they considered that at all
Hana

I don’t see myself as a low carber as I am still finding my way, although I have had to cut out the starchy carbs and now get mine from fruit and vegs in the main.

Yes the article is interesting although it is not really clear where the starting point is.
Looking at this part:
“Cardiff University researchers looked at GP data on nearly 50,000 diabetes patients aged over 50, who had had their treatment regimen intensified to either a combination of oral therapies or a combination including insulin.”

If it says 'intensified' that surely indicates that there was already a treatment in place and I wonder what treatments they were. Is there are any other information that indicates the start position? :?

I don’t think it will be a surprise to anyone that to overdo anything is risky but if you get really low BG levels as a result of cutting out something that makes you feel ill there isn’t a great choice really as you can either:

1. Concentrate on keeping your levels to the higher perceived safe zone which may cause you to feel rough and ultimately you will then probably die from possible diabetes complications

OR
2. You can keep your levels down below (or even above) the perceived safe zone and perhaps enjoy a better quality of life through not feeling rough and die from "any cause".

HOWEVER, as we are all going to die I think I would primarily like to enjoy my life in the meantime so would choose to eat in the way that will give me the chance of good health to be able to do so. Basically I will make my choices based on as much knowledge as I can obtain and by self testing. 8)

Thirsty, arguments on interweb message boards haven't been the same without you, my friend.

I should think that this is actually quite a good advert for the minimal/no meds low-carb brigade.

They get to avoid the highs (plus progression and complications), while avoiding the lows which would appear to come along with intensive meds/insulin treatment.

This was a 22 year study of Type 2 diabetics, 50 years and older when the study started.
What I would like to know is if there is anyone on the forum who was 50yrs. old or older when the study started and who still has good control without any medication, regardless of how they manage their diabetes.
I have been a Type 2 for 7yrs. and to date am managing to control my diabetes with diet alone. Is it inevitable that in the future I will need medication or can someone categorically say that they are still managing this way after 20yrs.plus? I cannot find any studies that say that diet alone will control it forever.

Unless someone has a subscription to the lancet we can't read the actual study but reading behind the lines of the conclusion it seems that those who were 'sicker' had worse outcomes. It also seems to point to insulin as the villain of the piece but I wonder if that's because in the UK insulin therapy often isn't initiated until other stages of medication have failed.

More research is needed to establish HbA1c thresholds and the combination of drugs to be recommended for intensive treatment, with perhaps differing recommendations according to the patient - intensive treatment seems to be more beneficial for cardiovascular outcomes for those who are younger than 60 years, with a short duration of diabetes, and absence of microvascular and macrovascular disease."

Click to expand...

I agree with Dillinger that this study has little to do with any sort of diet, (though surprise, surprise, not with the rest of his sentiments )

hanadr said:

>>

In fact it's a scientific nonsense. Why should a low HbA1c in itself be dangerous? After all non-diabetics have Hba1cs in the range 3.5% to about 6% with an average around 5%. If it's that alone, then non-diabetics should be dropping like flies.

Hana

Click to expand...

but we are diabetic? Non diabetics have the luxury of a working pancreas don't they?

I don't really understand why this was aimed a Lowcarbers who aim to control their BG by diet and minimal or no medications. I would have thought that it applied to all diabetics on hypo inducing medications.

As a T2 on diet only, my intensive glycaemic control is solely down to the reduction of starchy carbs in my diet, as hypos are not an issue, I'm more concerned about the effects of hyperglycaemia, with that under control I don't see a low HbA1c as a problem. There are many studies about the benefits of keeping HbA1c below 6.5 are we to ignore these.

This really says it all,

There is indication that hypoglycaemia contributes to an augmented risk of mortality in patients with diabetes. Intensive glycaemic control increases risk of hypoglycaemia with some drugs more than with others. For that reason, the evaluation of risks associated with the different blood glucose-lowering regimens is essential. The authors in this study looked at the association between all-cause mortality and HbA1c in patients with type 2 diabetes, in a primary-care setting. They then established whether any evident association was independent of the diabetes treatment regimen.

Click to expand...

http://www.medicalnewstoday.com/articles/177199.php

Graham

As this is a thread of interest to Type 2 Diabetics the thread title has been changed to avoid confusion.

It has also been moved to the Type 2 area.

I don't understand - surely non-diabetics are not at greater risk than diabetics - and they will have lower average Hba1cs.

My latest is 5.9 - and I am not on any diabetes medication.

I thought this was good news - am I wrong? :?

I should add that I am not a low carber - but I follow a low glycemic load diet.

We are all part of the ultimate statistic – ten out of ten die. :lol:
.

I have emailed one of the researchers, because I think the reporting of this has skewed the meaning.
I can see no reason at all why a low HbA1c of itself should be harmful: diabetic or not. We don't see loads of non-diabetics dropping like flies because of their low HbA1cs. What I do see as dangerous is the use of large doses of a variety of toxic drugs to achieve thal low Result.

As far as I can make sense of this, diet controlled diabetes, isn't going to be a problem.
I must declare an interest here. I've felt for ages that the attitude of "eat what you like and cover it with medication", is a potentially dangerous thing to do.
I think medical advice will have to go back to where it was before such a huge range of anti-diabetic medicine was available. i.e.controlling diet. There's too much of a high price to pay for "The easy way"
Hana

I was watching a video presentation by Irl Hirch in Vienna at the EASD conference this year online.
He categorically said that when the deaths were analysed, all the people who had died had hbaics over 7. He said the excess deaths were not related to lower hbaics.

What interests low carbing diabetics is that restricting carbs is a straight forward way to obtain normal blood sugars and less medications and insulin are required to achieve this. Also, once stablised insulin using low carbers tend to have steadier blood sugars and less unexpected hypos.

it doesnt specify what "those who died of any cause actually died of either. 50k isn't that many in a country of 60million. What about those with high BGs, or knocked down by a bus, car crash, zombie invasion? Thats how silly reports like this are. And lets face it, diabetes seems to get the blame for nearly any illness too....

I've read 3 articles concerning this research from 3 different sources, bbc, pulse and can't remeber the 3 one :roll:

But they all have a different slant to them...

But the gest I get is that for T2's aggressive treatment to get a low HbA1c may not be the wisest move for them... And indvidual targets should actually be set and not a over-all target for evey-one..

As to comments to what sort of diet a diaebtic should or shouldn't be using, everybody seems to be missing one point a very important point...

Not every-one wants or even can follow a extreme low carb diet, doesn't matter what merits this method does or doesn't have... So looking at how aggressivly one attempts to reduce the patients HbA1c with medication is important...

Perhaps some might wish to consider the methodology behind a longitudinal study.

With regard to the comment made in an earlier post::

“Why should a low HbA1c in itself be dangerous?” 

I don't think that the study is saying that at all. To me all that it is saying is that x patients were included in a longitudinal study and the known outcomes in terms of death were..... In simple terms someone put x into the sausage machine and what was observed coming out was y; that is, of the x patients involved, bearing in mind the associated patient medical data, the 'best survivors' (but ultimately deceased anyway) were those with an HbA1c at about 7.5 per cent. The study recognises that high HbA1cs are 'bad' and increase risk of death (and I suppose many on this forum would all 'intuitively' surmise that outcome - given the possible complications). The 'but' is the surprise that those with 'normal' (whatever that is) HbA1cs that many on this forum and elsewhere undoubtedly propound we should all strive towards, appear also to carry an increased risk of death earlier than those who have marginally less stringent controls.

The fact that 'normal' people do not appear to be dropping off like flies is neither here nor there. Diabetes, whether we like it or not, is associated to an increased risk of heart and stroke problems (and for some losing their feet), which make us all more vulnerable to an earlier that desired demise.

To me the article suggests that, for those of us who do manage tight control, don't be over zealous it might be counter-productive. For the bad guy's its 'well that's would we said'. And for the relaxed – live it and give it the best.

Need to re-think about my recent HbA1c of 5.6.

As for the initial reference to low carb it must be said that many of that ilk would have it that that is the way to achieving 'normal' HbA1cs.

Foggitthedoggit said:

“Why should a low HbA1c in itself be dangerous?” 

The fact that 'normal' people do not appear to be dropping off like flies is neither here nor there. Diabetes, whether we like it or not, is associated to an increased risk of heart and stroke problems (and for some losing their feet), which make us all more vulnerable to an earlier that desired demise.

.

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Would the increased risk of heart, stroke and amputations be applicable to diabetics who have "non-diabetic" HbA1cs as a result of diet and exercise alone?
Alison