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Welcome to Healthination. I'm Dr. Holly Atkinson. If you're a diabetic you're probably aware
that the question of how tightly to control blood sugar is a controversial topic. I sat
down with Dr. Derek Laroith, chief of the endocrinology, diabetes, and bone disease
department at the Mount Sinai School of Medicine, to talk about the controversy and what's best
for type 1 and 2 diabetics.
There's a lot of discussion in the press about these issues, but what's not spelled out to
the patients is if you take the type 1 diabetic, that sugar control is critical. It's been
showed in some of the best trials that type control prevents or delayed the progression
of eye disease and kidney disease, and in fact years later after the trials are finished,
those type 1 diabetics who are well-controlled have less cardiovascular disease 10-15 years
later. So it's unquestionably type 1 diabetes that's critical. In the type 2 diabetics,
the controversy has been about tight glucose control and cardiovascular outcomes. What
was forgotten there is that written and other aspects of the micro vascular disease, the
small vessel disease, that was prevented. So tight glucose control is important for
both type 1 and type 2. regarding the cardiovascular outcomes in type 2 patients, the interpretation
of most physicians and investigators in the field of diabetes is that early in type 2
diabetes, tight control will give you a positive outcome. But later in the disease, after many
years of already having diabetes, you're surely gonna have some underlying cardiovascular
disease, or if you really have evidence of cardiovascular disease, then one should be
much more careful at how rapidly you bring the blood sugar under control, and that led
to some of the complications in those trials because much older patients were used with
established cardiovascular disease. We measure tight glucose control by measuring the A1C
because this is a measure that's done every 3 or 4 months, 3 or 4 times a year, and this
gives us an idea of the level of the blood sugar over the previous 3 months, and the
American Diabetes Association suggests that you try and reach a level of seven or slightly
less than seven. The American Clinical Endocrinologists believe you should get down to 6.5 but if
we could get more patients down to 7, even just below 7, we would have a much better
outcome in terms of the general population of diabetics. It used to be a mean of say
9. now we have the average one is down 8, or slightly less. But we still find that about
50% of our patients have not reached the goal which is let's say 7%, A1C.
Why is that?
Because there's so many variables. When you're overweight, you're insensitive to many of
the medications like insulin. Taking the medications, some good medications may be expensive because
they're new on the market. The difficulty with losing weight, with diet control, and
sometimes it's just the body just does not respond as well as you'd like it to, especially
when you're aging. One becomes more resistant to many of these effects.
So here's the insight. Tight blood sugar control for type 1 diabetics is critical. For type
2 diabetics who are newly diagnosed, tight control is also critical. But if you've had
type 2 diabetes for a while you'll need to be careful about how quickly you bring your
levels under control. Be sure to work closely with your doctor on the right strategy for
you.
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