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No benefit to too tight a control of type1 diabetes?
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<blockquote data-quote="kitedoc" data-source="post: 2149418" data-attributes="member: 468714"><p>Yes, doctors almost have a mantra about this: if you are having to use lots of insulin to get and keep BSLs down then hypos are more likely.</p><p>But see Pediatrics March 2018 Management of Type One Diabetes On Very Low Carbohydrate Diets authors Lennerz, Ludwig et al you can see average HBA1C around 5.6%, low BSL variability and very low hypo rate.</p><p>As the author of the Swedish study notes, the statistics are not as clear when looking at the lower HBA1C levels. How many TIDs did the study find say, at HBA1C of 5.5 % or lower? How can you compare the HBAIC and complication rate them if there were not many sub 5.5%?</p><p>Is this study really just proving the obvious? If you use a usual diabetes diet and try to achieve low HBA1Cs you are at increased risk of hypos?</p><p>The ADA would applaud as they have set upper limits for recommended acceptable BSLs for TIDs of 10 mmol/l. Why? Anecdotally US physicians are worried they will get sued if a patient of theirs suffers from a hypo, never mind that the recommended BSL ranges may lead to their patients being at risk of diabetes-related complications later on when it may be more difficult to prove what caused the complications to occur.</p><p>The ACCORD study did show increased risk of CVD in T2Ds and TIDs for HBA1C below the 6 to 7% HBAIC range but not why. Other similar studies showed lower risk as HBA1C was progressively lower. The difference between the studies depended on how you divided up the HBAIC intervals vs the CVD occurrence. So 2 studies (ACCORD and one other) showed the U type curve, (higher risk at low and high HBAIC) whereas 2 showed a line with lower risk as HBAIC became lower. So what to believe? It sounds like statistics may be born liars, but which pair of studies do you believe? And intuitvely, if CVD is lower in non-diabetics (with their normal HBAICs) than TIDs with higher HBAICs, I know what I am going to go with.</p></blockquote><p></p>
[QUOTE="kitedoc, post: 2149418, member: 468714"] Yes, doctors almost have a mantra about this: if you are having to use lots of insulin to get and keep BSLs down then hypos are more likely. But see Pediatrics March 2018 Management of Type One Diabetes On Very Low Carbohydrate Diets authors Lennerz, Ludwig et al you can see average HBA1C around 5.6%, low BSL variability and very low hypo rate. As the author of the Swedish study notes, the statistics are not as clear when looking at the lower HBA1C levels. How many TIDs did the study find say, at HBA1C of 5.5 % or lower? How can you compare the HBAIC and complication rate them if there were not many sub 5.5%? Is this study really just proving the obvious? If you use a usual diabetes diet and try to achieve low HBA1Cs you are at increased risk of hypos? The ADA would applaud as they have set upper limits for recommended acceptable BSLs for TIDs of 10 mmol/l. Why? Anecdotally US physicians are worried they will get sued if a patient of theirs suffers from a hypo, never mind that the recommended BSL ranges may lead to their patients being at risk of diabetes-related complications later on when it may be more difficult to prove what caused the complications to occur. The ACCORD study did show increased risk of CVD in T2Ds and TIDs for HBA1C below the 6 to 7% HBAIC range but not why. Other similar studies showed lower risk as HBA1C was progressively lower. The difference between the studies depended on how you divided up the HBAIC intervals vs the CVD occurrence. So 2 studies (ACCORD and one other) showed the U type curve, (higher risk at low and high HBAIC) whereas 2 showed a line with lower risk as HBAIC became lower. So what to believe? It sounds like statistics may be born liars, but which pair of studies do you believe? And intuitvely, if CVD is lower in non-diabetics (with their normal HBAICs) than TIDs with higher HBAICs, I know what I am going to go with. [/QUOTE]
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