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4 Responses

  1. NAtalie hodge
    NAtalie hodge August 7, 2011 at 12:09 pm | | Reply

    Thanks will for your lighthearted advice! Thanks Amy for your work! I am a pediatrician, hacker, iOS developer and also mom of newly diagnosed Kennedy 11 with type 1. We are 44 days out from diagnosis (but who’s counting?)

    Just want to let you’all know the significant contribution that the doc has made for me as a new parent dealing with this disease.

    Amy and I spoke at a recent mayo clinic transform symposium about our unusual roles in creation of healthcare value through web content and community. The value creation of the doc is undeniable.

    Anywho, thanks again and look forward to seeing my crazed and somewhat forward thinking posts reflecting on the era of diabetes management that my daughter is entering… One of patch pumps, accurate cgm, and promising pediatric open loop trials, truly an exciting time! That is if my kid doesn’t die in her sleep tonight from hypoglycemia… Sigh…

    Best, Natalie
    http://Www.Personalmedicine.com
    http://Www.personalmedicineofkentucky.com

  2. bsc
    bsc August 8, 2011 at 5:24 am | | Reply

    I wish the ACCORD study had never existed. The results have been spun out of control so bad, there seems to be no end to the confusion.
    And again we have another example. The ACCORD did not find that hypos (or insulin use) were related to excess mortality. Here is a discussion from the principle investigator:

    Endochrine Today “ACCORD: Intensive glucose control not to blame for excess mortality”, June 10, 2009 on the ADA 69th Scientific session (http://www.endocrinetoday.com/view.aspx?rid=40829).

    “HbA1c was associated with hypoglycemia but not in the relationship we expected,” said Denise Bonds, MD, MPH, project officer for ACCORD at the National Heart, Lung and Blood Institute, National Institutes of Health.

    Severe hypoglycemia was associated with higher risk for death in both treatment groups but a lower risk in the intensive group vs. standard group (HR=1.28 vs. HR=2.87). Further, risk for hypoglycemia was lower in the intensive control group who achieved the target goal faster compared with the standard group (HR=0.86 vs. HR=0.72). Importantly, hypoglycemia did not account for overall mortality findings.

    “Hypoglycemia was felt to play no role in most deaths,” Bonds said. Few deaths occurred within 90 days of a documented episode of severe hypoglycemia.

    I have long suspected that the excess mortality in ACCORD could be attributed to the extensive use of AVANDIA which was used in the majority of patients in the intensive arm. AVANDIA has been implicated as causing heart problems and will be removed from the market in November (http://www.fda.gov/Drugs/DrugSafety/ucm255005.htm). The inability of the study team to “prove” that AVANDIA was not the cause of excess mortality says reams about the situation.

    And remember, the AACE suggests for healthy people getting your A1c “in general < 6.5 for most; closer to normal for healthy." Closer to normal means lower. If you have other problems and are less healthy you should consider a more lenient control. But for many of us, higher blood sugars are "not better."

  3. Hans
    Hans August 8, 2011 at 9:13 am | | Reply

    just another Riddle little update on your ACCORD info:
    “The answer was no. People who rapidly lowered their A1c didn’t have excess deaths,” Riddle said. In fact, “it was the ones who couldn’t bring their A1c’s down that had increased mortality.”
    http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=9287-tight-blood-sugar-control-may-not-harm-diabetes-patients&catid=1&Itemid=8

  4. Natalie
    Natalie August 10, 2011 at 10:45 pm | | Reply

    Thank you, Wil, for your response. Since I don’t have access to Diabetes Education (my insurance has a grand lifetime benefit of $50, which didn’t even cover one hour), it is nice to be able to ask my weird questions!

    The reason I have been able to achieve such good control is that I am limiting my carbs to those found in vegetables and occasionally small portions of fruits and dairy. No added sugar (read the label), and minimal high-carb, low nutrition foods like bread, rice, potatoes, pasta, cereal, etc. For me, it works.

    I went to the AADE convention last week, and heard some really interesting presentations called 1) Food, Fat and Satiety, explaining about all the hormones involved, and 2) Fructose and Cardiovascular Disease, a not so sweet connection. I don’t know if you have access to the Power Point slides, but they are very worth viewing. I learned a lot, but no one answered my question like you did! :-)

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