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Message: <blockquote data-quote="KennyA" data-source="post: 2728303" data-attributes="member: 517579">Having had a chance to read the NNT reference - it's from 2014.... it says some things that these days sound incredibly dated (my emphasis is in underline) :There are no data to support the statement that tight glycemic control is lifesaving, and indeed these considerable data suggest that it is not. The median time for mortality outcomes was short, roughly two years, and perhaps over many years of using this approach there may be an identifiable mortality benefit, though if so it is likely to be very small based on the point estimates and sequential analyses performed by the Cochrane authors.Hypoglycemia is a major problem for diabetics, and can in extreme cases be fatal or neurologically devastating. This problem did not, however seem to increase mortality which is reassuring for those at higher risk of limb amputation, or any others for whom this approach may be used or considered.These data should not be interpreted to mean that any attempts to control glucose levels have been proven not to work. While it is true that glucose controls are not the cause of type 2 diabetes, but rather a symptom of an underlying metabolic disorder, treating this measurable symptom may have benefits. Unfortunately at this point even this remains unproven, despite being intuitively likely. Trials examining diet or lifestyle approaches versus directed glucose control are badly needed to determine the degree to which treating glucose levels is beneficial in comparison to other approaches.Finally, we did not address microvascular complications here because we find these not to be patient-oriented. Nephropathy (protein in the urine) and retinopathy (retinal changes on exam) may both be harbingers of later problems, and both are reduced by tight glycemic control, however existing data argue strongly that clinically important outcomes like kidney failure and vision loss occur far less than cardiovascular outcomes....It also assumes, I think,  that "tight glycaemic control" can only be achieved by a drug regime, and therefore you have the hypo risk that they say is a "major problem for diabetics" - begging a question of their understanding of non-pharmacological interventions, and the differences between T1 and T2. You might, for a different view,  want to look at (for example) the David Unwin papers on his use of low carb in an ordinary GP setting.  Links: <a href="https://wchh.onlinelibrary.wiley.com/doi/10.1002/pdi.1835" target="_blank">https://wchh.onlinelibrary.wiley.com/doi/10.1002/pdi.1835</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695889/" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695889/</a>This is a similar paper, but from the USA. <a href="https://drc.bmj.com/content/bmjdrc/8/1/e000980.full.pdf" target="_blank">https://drc.bmj.com/content/bmjdrc/8/1/e000980.full.pdf</a></blockquote>

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