Michael.Massing + tight + glucose + control   32

Glycemic Control in Nonpregnant Adults With Type 2 Diabetes | Guidelines | JAMA | JAMA Network
In the United States, type 2 diabetes affects 30 million people and is a major cause of morbidity and mortality.1 Glycemic control has been shown to reduce diabetes complications, particularly for microvascular disease.2,3 However, increasing recognition of adverse events due to intensive diabetes treatments has prompted major disagreements about optimal glycemic targets.
glycemic  control  tight  management  glucose  complications  late-stage  symptoms  risk  mitigation  prevention  microvascular  diabetes  type  2  T2D 
yesterday by Michael.Massing
Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals
The mean 24-hour interstitial glucose concentration under everyday life conditions was 89.3 ± 6.2 mg/dl (mean ± SD, n = 21), and mean interstitial glucose concentrations at daytime and during the night were 93.0 ± 7.0 and 81.8 ± 6.3 mg/dl, respectively. The highest postprandial glucose concentrations were observed after breakfast: 132.3 ± 16.7 mg/dl (range 101–168 mg/dl); peak concentrations after lunch and dinner were 118.2 ± 13.4 and 123.0 ± 16.9 mg/dl, respectively. Mean time to peak glucose concentration was between 46 and 50 minutes. After ingestion of standardized meals with fast absorption characteristics, peak interstitial glucose concentrations were 133.2 ± 14.4 and 137.2 ± 21.1 mg/dl, respectively. Meals with a higher fiber, protein, and fat content induced a smaller increase and a slower decrease of postprandial glucose concentrations with peak values of 99.2 ± 10.5 and 122.1 ± 20.4 mg/dl, respectively.


This study provided continuous glucose profiles in nondiabetic subjects and demonstrated that differences in meal composition are reflected in postprandial interstitial glucose concentrations. Regarding the increasing application of continuous glucose monitoring in diabetic patients, these data suggest that detailed information about the ingested meals is important for adequate interpretation of postprandial glucose profiles.

Keywords: continuous glucose monitoring, continuous glucose profiles, healthy subjects, interstitial fluid glucose, postprandial glucose
Go to:
Tight glycemic control has been shown to reduce the risk of complications in patients with type 1 and type 2 diabetes.1,2
tight  glucose  control  management  interstitial  blood  diet  cycle  metabolism  normoglycemia  peak  postprandial  peer-reviewed  research  in  vivo  human  rhythms  circadian 
november 2017 by Michael.Massing
More Magnesium, More Benefit in Prediabetes?
The glucose tolerance of approximately 50% of the patients receiving magnesium supplementation improved from impaired to normal, compared with 7% in the placebo group.

A cross-sectional study also associates hypomagnesemia with an increased risk for diabetic complications, including retinopathy, nephropathy, and foot ulcers.[7]

Supplemental Magnesium

Magnesium intake in clinical studies has been around 400 mg/day, which is the recommended dietary allowance of magnesium for men. For women, 300-310 mg/day is the recommended dietary allowance.[8] Only about 50% of Americans aged 1 year or older receive the recommended amount of dietary magnesium.[9] Thus, it may be reasonable to advise patients who are at risk for diabetes to increase magnesium intake. Foods that have high amounts of magnesium include nuts (eg, almonds, cashews, and peanuts), vegetables (eg, spinach, avocado, and edamame), and whole grains.[10]

For patients who cannot meet magnesium requirements through foods, supplemental magnesium not exceeding 350 mg/day could be used. Supplemental magnesium may cause diarrhea, nausea, and cramping. Patients with renal impairment should avoid magnesium supplements unless prescribed by a healthcare provider.[10] Products containing magnesium may interact with other medications and should be separated by at least 2 hours to prevent drug interactions.[11]

The American Diabetes Association does not support the routine use of magnesium supplementation in patients with diabetes but does recommend intake of vegetables, whole grains, and legumes.[12] Larger studies are needed to determine the role of magnesium supplementation in preventing prediabetes, type 2 diabetes, or complications of diabetes.
magnesium  Mg  supplements  correlation  impaired  fasting  glucose  prediabetes  diabetes  type  2  T2D  peer-reviewed  research  overview  risk  benefit  diet  dietary  foods  retinopathy  nephropathy  foot  ulcers  mitigation  prevention  symptoms  late-stage  complications  behavioral  self  care  treatment  management  tight  control  human  clinical  trial  in  vivo  situ 
march 2016 by Michael.Massing
Good Control Now = Lifetime Benefit - Diabetes Self-Management
Two famous studies showed that tight control of glucose did not cause a statistically significant reduction in heart attacks or early death. But roughly 20 years after the studies ended, tight control subjects are living longer and healthier than those who were in the comparison groups. What is going on?

This long-delayed benefit is called the “legacy effect.” It was found in follow-up of patients in the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS)....

Same in Type 2
The UKPDS tried to do for Type 2 diabetes what DCCT had done for Type 1: show the effects of tight glucose control. UKPDS included about 5,000 recently diagnosed people with Type 2. Half were assigned to a tight control group, defined as a fasting blood sugar (FBS) below 108 mg/dl (6.0 mmol/ml). In practice, the tight control group had a median (midpoint) A1C of about 7.0.

Just as in DCCT, people receiving “intense control” had fewer eye, kidney, and nerve problems. But heart problems and strokes were no different for the two groups at the end of the study. After ten years, “no attempts were made to maintain previously assigned therapies,” and glucose levels in the two groups became similar. However, 15 years later, the tight control group has had far fewer cardiac events and a lower death rate.
tight  control  SMBG  legacy  effect  insulin  treatment  self  mortality  benefit  diabetes  glucose  self-monitored  blood  monitoring  management 
september 2015 by Michael.Massing
History of Diabetes: American Diabetes Association®

The Diabetes Control and Complications Trial (DCCT) showed that keeping blood glucose levels as close to normal as possible slows the onset and progression of eye, kidney, and nerve diseases caused by diabetes. In fact, it demonstrated that any sustained lowering of blood glucose helps, even if the person has a history of poor control.

Repaglinide, brand name Prandin (Novo Nordisk) is developed. Repaglinide belongs to a class of drugs known as meglitinides. They stimulate insulin secretion in the presence of glucose.

The United Kingdom Prospective Diabetes Study (UKPDS) shows that people with type 2 diabetes who practice tight control of blood sugar levels and blood pressure levels reduce their risk of complications, similar to the results of the DCCT in people with type 1 diabetes. Together these two studies transform the nature of diabetes care around the world. [They do? - DMM]

The results of the ACCORD, ADVANCE and VADT studies are published and presented at the American Diabetes Association Scientific Sessions. All three studies fail to show a benefit of intensive glycemic control on cardiovascular outcomes in people with type 2 diabetes who are at high cardiovascular risk. The results from these studies lead to clinical recommendations that call for a more individualized approach for setting glycemic goals and treatment targets.
DCCT  tight  control  diabetes  complications  late-stage  symptoms  risk  benefit  blood  glucose  sugar  history  timeline  research  peer-reviewed  drug  effects  cardiovascular  self-monitored  self  monitoring  SMBG  comorbidities  late  end-stage  management  treatment 
february 2015 by Michael.Massing
'Vindication' for a Diabetes Expert - NYTimes.com
"Those in the study followed some version of a high-carbohydrate diet and used large doses of insulin," [Dr. Bernstein] said, "while our regimen for Type I insulin-dependent diabetes is for a very low-carbohydrate diet and very small doses of insulin because insulin does not work as fast as carbohydrate in affecting blood sugar. And when you get large amounts of both, you get big deviations from a level blood sugar."
Richard  control  tight  peer-reviewed  sugar  blood  research  K.  low-carbohydrate  carbohydrate  glucose  low-carb  Bernstein  diabetes  benefit  self-monitored  self  monitoring  SMBG  management  treatment 
january 2015 by Michael.Massing
Body's circadian rhythm tightly entwined with blood sugar control | News Center | Stanford Medicine
[Absent from this discussion is any notion that diabetics might use the circadian glucocorticoid cycle to manage blood glucose through diet and other behavior.—DMM]

“Some very simple modifications in how we use glucocorticoids may change whether these drugs cause diabetes,” Feldman said. Giving prednisone in a daily pattern that matches the body’s natural glucocorticoid cycle—with a daily peak in the early morning—might help solve the problem, he said. And because prednisone is already approved for human use, clinical trials of this idea would be fast and simple.

Feldman’s findings might also be applied to aid people who already have diabetes, possibly making it easier for them to artificially control their blood sugar with medications. And the work provides the beginnings of a concrete explanation for the down side of night-shift work.
circadian  diabetes  blood  sugar  glucose  correlation  research  peer-reviewed  in  vitro  vivo  animal  model  tight  control  self  care  treatment  benefit  self-monitored  monitoring  SMBG  rhythms  glucocorticoid  management  diet  meal  planning  timing 
july 2014 by Michael.Massing
30 Years Later, a Landmark Study Lives On: Diabetes Forecast Magazine
The trial ended about a year early because the results were so clear-cut. The risk of the development and progression of complications was significantly lower in the intensive therapy group; members had less than half the risk of developing retinopathy, nephropathy (kidney disease), and neuropathy (nerve damage).

Almost all of the benefit was accounted for by the difference in A1C levels between the two treatment groups. "You didn't have to get to a magic number to see benefit," says Gayle Lorenzi, RN, CDE, study coordinator at the University of California–San Diego. "Any improvement in glucose control resulted in risk lowering. If you went from an A1C of 10 percent to an 8, risk was still reduced."

The benefits weren't limited to those in perfect health at the study's start. The thinking used to be that once a patient had signs of complications, the damage would inevitably worsen, says Rose Gubitosi-Klug, MD, PhD, principal investigator at Case Western Reserve University. But DCCT showed that "even if you have complications, you can slow the progression," she says....

And though we now know intensive glucose control reduces the risk of complications, the health care system doesn't provide free, high-level care like the intensive group received. Many people see just a single provider for two to four visits a year.
diabetes  type  1  tight  control  intervention  behavioral  peer-reviewed  research  clinical  in  vivo  human  randomized  controlled  trial  self  care  blood  glucose  management  T1D  ethics  standard  of  healthcare  DCCT  behavior  treatment  benefit  self-monitored  monitoring  SMBG  retinopathy  nephropathy  risk  mitigation  prevention  symptoms  late-stage  complications  situ 
february 2014 by Michael.Massing
Diabetes Remission: what they don't say (enough)
Diabetes is complicated. Volumes of research produce inconclusive and contradictory results.
Diabetes-related research may be badly reported, or just plain bad.
Evaluating research, assessing risks and benefits, and devising a working strategy for self care are not helped by the cognitive deficits, depression, and fatigue associated with blood sugar highs and lows.
Drugs used to treat diabetes and/or its comorbidities may increase the risk of death or morbidity, including onset of diabetes itself and incidence of comorbidities.
Blacks, Hispanics, American Indians, and Pacific Islanders are known to be at higher risk for developing diabetes. Less discussed are the risks conferred by a range of circumstances: socioeconomic status, stress, sleep, inadequate health literacy and education, location, and exposure to plastics and to environmental pollution. These factors often trump genetics; they can increase diabetes incidence and/or worsen outcomes.
Lack of professional consensus, balky insurance plans, and physicians' disregard of patient-reported data may all interfere with getting adequate testing supplies to carry out tight glucose control.
T2D  diabetes  type  2  etiology  correlation  research  peer-reviewed  remission  factor  tight  control  glucose  benefit  self-monitored  blood  self  monitoring  SMBG  plastics  depression  comorbidities  stress  distress  risk  management  treatment  genetic  genetics 
august 2013 by Michael.Massing
Close Eye on Blood Sugar Aids Glycemic Control
[Some studies have shown that clinicians and patients make little use of self-monitored blood glucose] data in order to improve outcomes. But [this study and other recent work have] shown that monitoring that is highly structured, in terms of both timing and frequency, may help improve outcomes -- even in patients who have a lower HbA1c but aren't quite at glycemic targets....
The researchers also found in the ITT analysis that prescriptions for diabetes medications were changed more often at visits two, three, and four for the intense-monitoring group than for controls...."structured SMBG data prompted clinicians to adjust therapy earlier and more intensively in contrast to the clinical inertia often seen in the management of patients with type 2 diabetes"
T2D  research  babies  type  to  management  control  blood  glucose  sugar  intervention  treatment  self  care  A1c  human  in  vivo  medical  clinical  diabetes  2  peer-reviewed  goals  improvement  benefit  intensive  tight  behavior  behavioral  trial 
june 2013 by Michael.Massing
ACCORD Travesty :: David Spero :: Diabetes Self-Management
I may say some nasty and completely true things about the medical establishment.
I only started paying attention [to the ACCORD study] when the intensive blood sugar control arm was canceled. The more I found out about it, the angrier I got...ACCORD is a great example of most of what is wrong with American medicine, and with the way our media covers it....
From the beginning, ACCORD was a drug trial. The study called for participants to receive diet and exercise counseling if they wanted it, but set no guidelines for the counseling. There was no self-management group. It was all, repeat all, about the drugs.[Encouraging participating doctors to unsystematically and aggressively prescribe multiple drugs all but guaranteed drug interactions and adverse effects.]
In February, NHLBI stopped the intensive blood sugar control arm because more of the participants in that group were dying than in the normal care group.
Then came the outrageous part: NHLBI and media dummies came out saying that the intensive group’s blood sugars had been too low....
What kind of madness is this? You throw scads of drugs at sick people, treating only their numbers, not their bodies and lives as a whole. Then, when they die, you say it couldn’t have been the drugs. It must be the numbers. And you tell people with diabetes to get their blood sugars up.
You better believe that if ACCORD had shown a 10% decrease in cardiac deaths from intensive blood glucose management with drugs, those drugs would have become standard therapy for every person with Type 2 in the country. Nobody in the media would have said, “It wasn’t the drugs.” The drug companies would have made billions. That was the goal of the trial.
A1c  risk  tight  control  David  Spero  research  criticism  health  literacy  peer-reviewed  science  diabetes  management  mortality  benefit  bad  corruption  medical  pharmaceutical  industry  news  media  journalism  reporting  drug  effects  adverse  healthcare  self  care  polypharmacy  outbasket  corporatism  capitalism  glucose  outbox  exercise  physical  activity  correlation  self-monitored  blood  monitoring  SMBG 
february 2012 by Michael.Massing
Benefits of Tight Blood Pressure Control in Diabetic Patients With Hypertension
In 2008, when the UK Prospective Diabetes Study (UKPDS) group presented their 30-year findings concerning the possible sustained effects of improved glycemic control after 10 years of extended follow-up in type 2 diabetic patients, a so-called “legacy effect” was reported to address the long-term emergent and/or sustained benefits of early improved glycemic control. Opposite results were obtained by the Hypertension in Diabetes Study (HDS) carried out in the frame of UKPDS, with no evidence of any legacy effect on cardiovascular (CV) outcomes for an initial 4-year period of tight blood pressure (BP) control. Thus, it was concluded that BP control has to be continued over time, since, although it had a short time-to-effect relationship in preventing stroke, BP control was associated with a short persistence of its clinical benefits once the intervention was discontinued. These findings are unique because, whereas most interventional trials in hypertension that included diabetic patients have shown a reduction in CV outcomes shortly after starting treatment, only the UKPDS-HDS specifically explored the possible persistence of clinical benefits after discontinuing intensive BP-lowering intervention. This article aims to provide a critical interpretation of the UKPDS findings of lack of BP legacy, in the context of the currently available evidence on the benefits of antihypertensive treatment. The importance of effective BP control in type 2 diabetic patients to prevent CV outcomes and other diabetes-related complications is underlined, with emphasis on early, tight, and continuous BP control to optimize patients’ protection.
hyperglycemia  hypertension  high  blood  pressure  glucose  intervention  treatment  legacy  effect  early  aggressive  tight  control  what.I'm.reading  self  care  dysglycemia  morbidity  risk  medical  research  diabetes  T2D  correlation  benefit  self-monitored  monitoring  SMBG  behavior  behavioral  peer-reviewed  dcde 
january 2012 by Michael.Massing
Review: Does hypoglycaemia cause cardiovascular events?
Strict glycaemic control is strongly advocated in people with type 2 diabetes to prevent vascular disease. However, the outcomes of two large clinical trials have indicated the potential dangers of pursuing this policy in those at high risk of cardiovascular disease, with an excess of fatal vascular events being associated with a higher frequency of severe hypoglycaemia. Hypoglycaemia secondary to insulin and sulphonylurea therapy is often associated with serious morbidity; anecdotal evidence has long implicated hypoglycaemia as a potential cause of myocardial ischaemia or a cardiac arrhythmia. Hypoglycaemia provokes sympatho-adrenal activation and counterregulatory hormone secretion, which exert pronounced cardiovascular effects. Although well tolerated in healthy people, the superimposition of these profound physiological effects on a diseased coronary vasculature and a dysfunctional cardiac conductive system may induce serious or even fatal cardiovascular events. These risks should influence therapeutic targets and the approach to diabetes management in people with diabetes with established vascular disease in whom exposure to severe hypoglycaemia could be dangerous.
diabetes  treatment  tight  control  blood  glucose  hypoglycemia  risk  heart  circulation  cardiovascular  benefit  self-monitored  self  monitoring  SMBG  management 
january 2012 by Michael.Massing
Intensive glucose-lowering treatment associated with cardiovascular benefit in type 2 diabetes - DiabetesPro - American Diabetes Association
Meta-analysis of four clinical trials (ACCORD, ADVANCE, UKPDS and VADT) assessed ` effects of more intensive...glucose control on the risk of cardiovascular events in patients with type 2 diabetes. The meta-analysis comprised 27,049 participants who experienced a total of 2,370 major cardiovascular events over 4.4 years. The risk of having a major cardiovascular event was reduced by 9% in patients who received the more intensive compared with the less intensive glycemic control (HR, 0.91; 95%CI, 0.84-0.99). In particular, the risk of nonfatal/fatal myocardial infarction was reduced by 15% in the more intensive versus the less intensive treatment group. However, the risk of severe hypoglycemia was increased by more than 2-fold (HR, 2.48; 95%CI, 1.91-3.21) in patients receiving the more intensive glycemic control. Thus, caution should be exercised in assigning intensive glucose-lowering strategies to patients with type 2 diabetes (Turnbull, F.M. et al. Diabetologia 2009, 52(11): 2288).
diabetes  tight  control  mortality  cardiovascular  disease  heart  CVD  risk  benefit  hypoglycemia  trade-offs  type  2010  controversies  via:diabetes.org  exercise  physical  activity  glucose  self-monitored  blood  self  monitoring  SMBG  management  treatment  from delicious
april 2011 by Michael.Massing
HbA1c [shows average blood sugar control over several months. A value o≥ 6.5% is used] as a diagnosis for diabetes....
The ADA recommends that the HbA1c be performed at least twice annually, and up to [4 times a year for individuals adjusting treatment or missing treatment goals;] the AACE recommends [type 2 diabetics test] at least quarterly. Patients who use insulin to control their type 1 or type 2 diabetes should have the test performed quarterly....
In [non-diabetics, some] 5.5 to 9% of total hemoglobin is glycated (around 5% when measuring HbA1c). [well-controlled diabetics can achieve levels within this range]...
[The American Association of Clinical Endocrinologists recommends diabetics aim for a target HbA1c of ≤ 6.5%]....
[Average HbA1c in diabetics] at diagnosis is 10.9 to 15.5%. HbA1c levels usually range from 8 to 11.9% in uncontrolled diabetes. With proper treatment, and tight control techniques, people with diabetes can attain the "normal" [HbA1c levels].
A1c  ADA  AACE  normal  remission  blood  glucose  target  management  via:dLife.com  control  self  care  tight  diabetes  diagnosis  treatment  from delicious
march 2011 by Michael.Massing
The Real Lessons from ACCORD | Joslin Diabetes Center Blog
Another recently published study looking at the benefits of lower blood pressure and LDL cholesterol targets in people with Type 2 diabetes, used this language in their summary (excuse their ueber-academic style):
“As the effectiveness of therapy improves and new treatment strategies are widely applied, it is becoming more difficult to conduct a trial in which adequate numbers of clinical end points are achievable in a reasonable length of time for individuals without CVD (cardiovascular disease) at baseline.”
The translation: “Pesky patients with diabetes are living too long, and no one is getting heart disease! How can we do our research?!” These studies also serve as a reminder for Type 2 diabetics that glucose control is not the single most important factor in avoiding cardiovascular complications. Blood pressure control is probably the most important, followed by keeping your LDL cholesterol on target, and then by glucose control.
diabetes  heart  circulation  risk  reduction  health  literacy  blood  fats  lipids  cholesterol  pressure  management  research  analysis  tight  control  via:joslin.org  factor  burden  benefit  science  criticism  bad  medical  reporting  correlation  type  2  T2D  prevention  protection  cardiovascular  life  expectancy  longevity  mortality  interpretation  ACCORD  glucose  self-monitored  self  monitoring  SMBG  hypertension  high  treatment  peer-reviewed  etiology  from delicious
march 2011 by Michael.Massing
New Guidelines Issued on Optimal Hemoglobin A1C Targets for Type 2 Diabetes
Below 7%, below 6.5% OR NORMAL?
When do we [tell the public the honest truth]? To reduce your risks as if you did not have diabetes, then you need an A1c that represents a healthy individual without diabetes. [A] normal A1c for a healthy person without diabetes should be 4.3 to 4.6%. In the Epic-Norfolk study they showed that an A1c of 5% compared to an individual with an A1c of 6% had an increased risk of cardiovascular death of 28% higher.
In all of the recommendations they say that the A1c should be as low as possible without hypoglycemia. The ADA sticks with 7% or below, AACE stays with 6.5% or below, what does below mean? When we say it should be 7 or below then that is usually where most medical professionals stop being aggressive. We hear 7% we hear 6.5 % we even sometimes hear 6%.
If your child had diabetes, would you be satisfied at 6.5% or would you want it Normal, as if they did not have diabetes? Or would you like to wait 15 years and see what the studies tell us?
blood  glucose  target  management  normal  Richard  Bernstein  remission  diabetes  tight  control  A1c  medical  research  risk  comorbidities  symptoms  late-stage  complications  standards  morbidity  prediabetes  self  care  benefit  threshold  self-monitored  monitoring  SMBG  late  end-stage  diagnosis  treatment  from delicious
march 2011 by Michael.Massing
This Really Won't Hurt a Bit: Wireless Sensor Promises Diabetics Noninvasive Blood Sugar Readings: Scientific American
Glucose monitoring is extremely important to diabetics, to the extent that even somewhat invasive systems—including those that lance a patient's fingertips to draw blood—are used by millions and have sales in the billions, according to Langer. "Everyone I speak to in the diabetes field feels (transdermal monitoring is) very badly needed," he adds.<br />
<br />
England cautions, however, that finding an effective transdermal continuous glucose monitoring system is just one step in controlling diabetes. There still is no consensus on what constitutes the "right" glucose level in different patients, he says. Until that is determined, the benefit of having tighter control over blood glucose levels is an "open question," he adds. "We haven't had the technology to study this for any length of time."
blood  glucose  monitoring  transdermal  continuous  optimal  tight  control  self  care  diabetes  management  treatment  from delicious
march 2011 by Michael.Massing
Is Postprandial Glucose Control Important? Is It Practical In Primary Care Settings?
[Epidemiological studies show] elevated postprandial/post-challenge glucose to be independent and significant risk factors for macrovascular complications and increased mortality...The Diabetes Intervention Study. which followed newly diagnosed [type 2 diabetics], found moderate postprandial hyperglycemia to be more indicative of artherosclerosis than was fasting glucose, and found postprandial but not fasting glucose to be an independent risk factor for cardiovascular mortality....De Vegt et al. found [the degree of risk from] 2-h postprandial glucose concentration was nearly twice that [from A1C....Recent studies show] even moderate postprandial hyperglycemia (148–199 mg/dl) is not only more indicative of artherosclerosis than is fasting glucose, but also may have direct adverse effects on the endothelium.
diabetes  demographics  tight  control  blood  glucose  postprandial  glycemic  education  expectations  outcome  risk  benefit  management  clinical  guidelines  testing  schedule  monitoring  medical  research  treatment  self  care  epidemiology  patient  health  literacy  provider  caregiver  hyperglycemia  dysglycemia  morbidity  correlation  SMBG  self-monitored  from delicious
march 2011 by Michael.Massing
Counterpoint: Postprandial Glucose Levels Are Not a Clinically Important Treatment Target
The most important determinant of the postprandial glucose concentration is the preprandial level. Furthermore, the increment over the preprandial level is similar regardless of the preprandial value (40–42). [P]ostprandial hyperglycemia is best treated by lowering preprandial glycemia. Since randomized controlled intervention studies have clearly demonstrated that keeping A1C levels below 7.0% is beneficial for the microvascular complications of diabetes (although perhaps not for the macrovascular ones), that should be our primary goal. Once preprandial glucose targets are attained and if A1C levels are ≥7.0%, then and only then would specifically targeting postprandial glycemia be appropriate. If preprandial glucose values are reached and A1C levels are <7.0%, current clinical evidence is not strong enough to expose these patients to the increased risk of hypoglycemia by aggressively targeting postprandial glycemia.
[Useful numbers; analysis stuck in the intervention=drugs rut—DMM]
postprandial  blood  glucose  treatment  intervention  tight  control  self  care  hyperglycemia  dysglycemia  morbidity  risk  medical  research  T2D  diabetes  correlation  management  from delicious
march 2011 by Michael.Massing
The Benefits of Tight Control (Show All) :: Diabetes Self-Management
The way primary care is organized and reimbursed by insurance companies probably serves as a barrier to achieving optimal blood glucose control....
Before [Maine's] program existed, 80% of people with diabetes had received an HbA1c test within the past year. After a year, 93% of people had received one. The percentage of people with HbA1c values less than 7% rose from 41% to 49%—a 20% increase. The percentage of people with HbA1c values above 8% decreased from 31% to 24%, and the percentage of people with HbA1c values above 9.5% decreased from 13% to 9%. There were similar results in measures of LDL (or “bad”) cholesterol and blood pressure.
“This is not a question of bad doctors or bad patients...It is a question of a care model that is focused on illness instead of prevention, and systems that have been created that don’t accommodate a change in focus. We’re changing the focus, including offering financial incentives for physicians whose patients do better.”
delivery  system  illness  management  diabetes  treatment  remission  A1c  comorbidities  blood  glucose  eyes  neuropathy  kidneys  prevention  tight  control  chronic  health  care  healthcare  Maine  model  self  what.I'm.reading  burden  risk  benefit  T2D  research  kidney  disease  nephropathy  from delicious
february 2011 by Michael.Massing
Body's Circadian Rhythm Tightly Entwined with Blood Sugar Control
[Absent from this discussion is any notion that diabetics might use the circadian glucocorticoid cycle to manage blood glucose through diet and other behavior.—DMM]

Daily fluctuations in powerful hormones called glucocorticoids directly synchronize the biological clock as an integral part of our mechanism for regulating blood sugar....Feldman's team [applied] a synthetic glucocorticoid [in vitro to] mouse and human stem cells to see which genes responded. To the team's surprise, three genes known to control the biological clock changed their activity in a direct response to the hormone. Next, the researchers tested how the hormone's [in vivo] effect on the biological clock is linked with its other functions [by giving] the synthetic glucocorticoid to genetically engineered mice lacking a [gene that helps regulate] biologic rhythms. As...expected, genetically normal control mice responded to the glucocorticoid with blood glucose [rises.] In contrast, the genetically engineered mice were protected from harmful...effects on blood sugar levels[, showing] that blood sugar regulation and the biological clock are closely entwined.
blood  glucose  circadian  rhythms  diabetes  research  medical  biological  clock  cycles  metabolism  diet  schedule  peer-reviewed  correlation  tight  control  glucocorticoid  meal  planning  self  management  treatment  genetic  risk  genetics 
november 2009 by Michael.Massing
Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials | Skyler et al. Diabetes Care 32, 2009
[R]andomized controlled trials have demonstrated conclusively that the risk of microvascular complications can be reduced by intensive glycemic control in patients with type 1 and type 2 diabetes. In the Diabetes Control and Complications Trial (DCCT), there was an ~60% reduction in development or progression of diabetic retinopathy, nephropathy, and neuropathy between the intensively treated group (goal A1C <6.05%, mean achieved A1C ~7%) and the standard group (A1C ~9%) over an average of 6.5 years. The relationship between glucose control (as reflected by the mean on-study A1C value) and risk of complications was log-linear and extended down to the normal A1C range (<6%) with no threshold noted.
In the UK Prospective Diabetes Study (UKPDS), participants newly diagnosed with type 2 diabetes were followed for 10 years, and intensive control (median A1C 7.0%) was found to reduce the overall microvascular complication rate by 25% compared with conventional treatment (median A1C 7.9%).
blood  glucose  treatment  diabetes  symptoms  self  care  microvascular  retinopathy  nephropathy  outcomes  intensive  tight  control  management  benefit  late-stage  risk  mitigation  prevention  complications  behavioral  peer-reviewed  research  human  clinical  trial  in  vivo  situ 
april 2009 by Michael.Massing
(ADVANCE) World's Largest Trial of Intensive Glucose Control in Type 2 Diabetes Finds | ADA 68th Scientific Sessions, 2008-06-06
The world's largest diabetes trial has shown intensive blood glucose control in type 2 diabetes reduces the risk of complications--notably a 21% reduction in risk for kidney disease[, with] no evidence of any increased risk of death...."[M]ajor macrovascular events--heart attack, stroke and death from cardiovascular disease--were not significantly reduced with intensive glucose control, although there was a trend towards improvement in these outcomes. [A]ddressing all the major risk factors including blood pressure and blood lipids is required to prevent macrovascular disease," said Anushka Patel...."[I]ntensive control...reduced the combined risk of macrovascular and microvascular complications by 10%...driven largely by the microvascular results...[T]he 14% reduction in microvascular risk was driven mainly by nephropathy rather than retinopathy....We believe a protective effect [against cardiovascular disease] remains plausible..."
treatment  blood  glucose  risk  research  medical  biological  self  care  microvascular  retinopathy  nephropathy  outcomes  intensive  tight  control  management  benefit  late-stage  symptoms  peer-reviewed  mitigation  prevention  complications  behavioral  human  clinical  trial  in  vivo  situ 
december 2008 by Michael.Massing
Early Tight Control and Aggressive Treatment of Diabetes Pays Off
Medical scientists have discovered how the body's metabolism is "locked" into a diabetic state after only limited high glucose exposure....their finding confirms the need for very early tight control of glucose levels to avoid diabetic complication.
diabetes  blood  glucose  remission  antioxidants  treatment  self  care  tight  control  management 
july 2007 by Michael.Massing

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