Sunday, June 20, 2021

ACCORD Revisited

 In 2008, the results of the ACCORD "landmark" trial were published and were interpreted by some to mean that people with diabetes shouldn't get their blood glucose (BG) levels down to normal or below. This is because those whose diabetes was treated aggressively in this trial had greater mortality than those with less aggressive treatment.

Sadly, some physicians used these results to urge their patients to have higher hemoglobin A1c levels. Patients were reporting on diabetes lists that their doctors told them that their normal A1c levels were too low and they should get them up.

Careful analysis showed that in fact, the patients with increased mortality were those who used very aggressive treatment but despite this did not lower their A1c. So they had harm from the treatment without compensating benefit from lower BG levels. Those who got aggressive treatment and did lower their A1c got benefit.

"It has been recognized that patients treated intensively in ACCORD who attained a lower HbA1c had reduced risk of death compared to those treated intensively with little HbA1c reduction."

Unfortunately, these analyses did not get the wide publicity that the initial results did, so many busy physicians may not have read about them.

Now a new analysis of ACCORD  says that there is a subtype of type 2 that shows real benefit from intensive glycemic treatment.

Now, most patients will not be given genetic tests to determine if they are in this subgroup. And there might be other subgroups that these researchers did not study. However the analysis suggests that you should not accept without question the results of big studies of diabetes patients as applying to you. They probably will, but they might not.

If you're a physician, you need to work on the assumption that big trial results will apply to most of your patients, so you start by following their recommendations. But most of us aren't treating others, so what we really care about his how some approach will affect us.

This means we should test as much as we can, not just BG levels but other factors that affect our health, to see what works for us. We're fortunate these days because if we can afford it, we have access to a  lot of tests.

Stay informed. Read about the latest big studies. But read them critically and try to figure out if they make sense for you. Try what they suggest is beneficial, but don't apply the suggestions blindly.

In the long run, we have to be in charge of our health.

Friday, June 11, 2021

Self-control

Some time ago, in an online suport group I started, one woman said her biggest problem was that she couldn't stop eating potato chips after she'd had one.

I knew she lived alone, so I asked why she bought potato chips, and she said, "Because I like them."

I think this is a common problem. 

The most important thing you can do when you're diagnosed with type 2 diabetes is to accept that your life is going to have to change if you want to control it. Of course, that's not easy. If you live with others who aren't diabetic, you're probably going to keep buying food you shouldn't eat. That's difficult.

It should be easier if you live alone. If something makes your blood glucose spike, keep it out of the house. I suppose there are people with iron self-control who can eat just one bite of a cookie and no more. I'm not one of them.

Once before I got diabetes, I was on a diet to lose weight. I was avoiding sweets and they no longer had any appeal for me. Out of curiosity, I went into a bakery, and nothing looked good, but I bought a bag of cookies anyway to see if they'd taste good. I planned to eat just one, but as soon as I did I craved more and ate the whole bag.

So much for that approach. After that I just kept the cookies and pies out of the house. If I learn that a comet is headed for the earth and will destroy all life, I'm not going to call my nearest and dearest to say good-bye. I'm going to the bakery to buy a blueberry pie, and then I'm going to eat the whole thing.

Just my luck the comet will change course and we'll all be saved and my blood glucose will go over 500. Oh well. It would be fun while the pie lasted.

But until then I won't make pies, and I won't buy them. It's easier than trying to have self-control.

Wednesday, June 9, 2021

Obesity Benefit

 Most of the news about people who are overweight or obese is bad. We see a constant stream of articles saying obese people are at higher risk of this and they're at higher risk of that.

But here is an article saying that obesity protects you from dying from severe bacterial infections. In this study, 26 percent in the normal weight group were dead within a year. The corresponding figures in the groups with higher BMI were 9-17 percent. Full text is here. The authors note that although obesity is associated with higher survival in bacterial infections, it's associated with lower survival in viral infections. The authors have no explanation for this.

Other studies have shown similar effects, and this is called the obesity survival paradox.

 So does this mean we should all stuff ourselves with pies and cakes, hoping we'd become obese and thus have a better chance of surviving a bacterial infection? No. For one thing, we don't know we're going to get a severe bacterial infections, and for another, too many negative side effects are associated with overweight.

So as so many authors conclude, "more studies are needed."