Comments on: Tight control of diabetes matters

By: Anne Guglik, NREMT-P

Anne Guglik, NREMT-P — Thu, 29 Dec 2005 17:33:26 +0000

Would you rather have a patient who has early-stage neuropathy at age 30, like my sister, who believed her (first, and fortunately not present) endocrinologist instead of me (after all, I’m just a nosy paramedic who loves her) and allowed glucose levels in the low 200′s for the first few years after diagnosis (at age 17)?

By: antifaust » Blog Archive » Medlinks for 2005-12-28

antifaust » Blog Archive » Medlinks for 2005-12-28 — Wed, 28 Dec 2005 11:14:05 +0000

[...] Tight Control of Diabetes Matters DB’s Medical Rants: Study confirms benefits of tight glucose control in Type I Diabetes. A study concerning Type 2 Diabetes is ongoing. A reader, however, comments on the risks of hypoglycemia. (tags: issues diabetes) [...]

By: Roy M. Poses MD

Roy M. Poses MD — Thu, 22 Dec 2005 20:30:20 +0000

As best as I can tell, the article includes no data about survival rates in each group, and no data about possible adverse effects of tight control (e.g., hypoglycemic events and their consequences) at all.
If one assumes that the decreasing numbers in the groups from the start of the trial to year 11 found in Table 1 represent losses due to mortality, there appears to be no survival advantage from tight control. Given that there were fewer cardiac events in the tight control group, lack of survival advantage may be due to fatal hypoglycemic events in that group.
As I recall, the original DCCT trial showed a marked increase in hypoglycemic events in the tight control group, and thus it was not clear that the trade-off of less microvascular events due to tight control for more hypoglycemic events was favorable to patients.
In the absence of data about total mortality or about hypoglycemic events, this study does not convincingly argue for tight control as the best alternative for patients.