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Aug 22, 2011

Caution Against Intensive Glucose-lowering Treatments in Type 2 Diabetes

When it comes to managing and treating Type 2 Diabetes, diet, nutrition, and lifestyle make a world of difference. In some cases, more aggressive therapies, whether naturopathic or conventional, may be required. This is particularly important since diabetics are at increased risk for cardiovascular disease and microvascular complications (damage to smaller blood vessels).

Though many practitioners today prescribe intensive blood sugar lowering therapies (i.e. sulfonylureas, insulin) for their patients with type 2 diabetes, a recent study published in the British Medical Journal cautions against this type of practice. The study was a meta-analysis that looked at the results of 13 previous studies and included a total of over 35,000 diabetic patients. Out of all the participants, more than half (18,315) had received intensive glucose-lowering treatment while a little less than half (16,218) had received standard treatment.

Researchers concluded that intensive treatment not only failed to lower cardiovascular deaths and all-cause deaths in type 2 diabetics, it was also linked with a more than double-fold increased risk for severe hypoglycemia. Though intensive treatment was correlated with a 15% lowered risk for non-fatal heart attack and 10% risk reduction of microalbuminuria (a marker of kidney and cardiovascular disease), researchers were convinced that these small benefits were outweighed by the potential harm caused by dangerous levels of hypoglycemia. Furthermore, analysis of the higher quality studies revealed that use of intensive glucose lowering regimens significantly increased the risk of congestive heart failure while not providing any benefits to these diabetic patients.

The take home message from this study is that people with type 2 diabetes should be treated holistically. That is, practitioners should not aim solely to aggressively lower blood sugar levels with specific pharmaceuticals, but should instead use a multifactorial approach when treating a person. This involves appropriate diet and lifestyle interventions along with optimization of blood pressure and lipid profiles. Using a holistic approach, there is quite a bit of hope for sufferers of this all-too-common malady.

Dr. Shana McQueen

http://www.bmj.com/content/343/bmj.d4169.full