How Low Can You Go?

Diabetes treatment is becoming more, not less, controversial. Here is another in a series of recent articles trying to answer the question – how low should you go in trying to get glucose levels as close to normal as possible? In other words, the diabetes limbo game. In our first study, the glucose measurement used was an averaged level over about three months, called glycolated hemoglobin. The study proved too clear things – 1) with intensive therapy you can get lower, near-normal glyco-hemoglobins and 2) people died more frequently if you did. Yikes.

Is there a big flaw in this otherwise well-designed study? Well, sure. The issue is that going too low has always been a bad thing – too low glucose is called hypoglycemia, which can actually kill you rapidly if it becomes too extreme. The problem with this (and other) studies is that when you use an averaged value of blood sugar, you can’t know how often the average is the result of swinging from too low to too high, or if it is, instead, the result of living pegged at normal the whole time – both will give you the same number.

Just to highlight the controversy, check out this almost-simultaneously-published study, which showed that intensive therapy to achieve practically the exact same glyco-hemoglobin target reduced kidney disease by 21%, and reduced vascular problems (including the kidneys) by 10% overall. Could you guys please get together and straighten out your stories?

Bottom line: these results are (another) scary reminder for us all that hypoglycemia is deadly business. Let’s hope there’s better research, and more useful results forthcoming. Soon.

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