Quoted message said:Jenny,
I'm going mad - it wasn't Annette, but Robert Miles who posted the link,
over on mhd - http://www.healthscout.com/news/322/521085/main.html
"Overall, the women with diabetes had a threefold higher risk of getting
heart failure than did the women without diabetes, Bibbins-Domingo said."
They quote good control here as an fbg between 80-150 mg/dl - they don't
quote a1c figures - and I find that scary because mine hovers around the 104
mark. With my bg meter dictating a diet that runs to 50-60g carbs a day, I
don't like the implications of a low carb diet being associated with an
increased risk of heart disease, as your correspondent implies.
But Nicky...
That's a GIANT range of fasting BGs. What you get by corraling people
with 80-150 in the same group is many people in great control... and
many in terrible.
They may call 150 fasting "good"... but it ain't.
If they had broken out the results of their study into smaller
increments (80-100) (101-120) (121- 140) (141 +) I think you'd see the
folks who keep their BGs "normal" have a different outcome.
In addition, FBG may not be the best indication of glycemic control and
future complications.
Here's a study that corolates post prandial readings and mortality from
heart disease... maybe this will make you feel better:
Post-Meal Glucose Levels Better Predictors of Premature Mortality
than Fasting Glucose or HbA1c
MEXICO CITY, MEXICO -- November 7, 2000 - A new study indicates that
two-hour blood glucose (2h-BG) levels are better predictors for
all-cause mortality than either fasting plasma glucose (FPG) or
hemoglobin A1c (HbA1c). The study, which was presented here at the 17th
International Diabetes Federation Congress, provides further validation
of 2h-BG as an independent risk factor for death from heart disease.
The data underscore the significance of mealtime glucose "spikes" which
result from the body's inability to produce an early insulin response
after a meal. The acute toxicity of glucose spikes, as measured by 2h-BG
levels, is an independent risk factor for cardiovascular disease and
mortality and a better predictor than FPG, as seen in the published
research from the European DECODE study group. Cardiovascular disease is
a serious complication, causing a large proportion of deaths in people
with type 2 diabetes.
"These data further support the DECODE findings, but also demonstrate
that two-hour blood glucose is a better predictor of mortality than
HbA1c. This is true not just for cardiovascular mortality, but for death
from all causes," observed Jaakko Tuomilehto, M.D., Professor of Public
Health at the University of Helsinki and at the Diabetes and Genetic
Epidemiology Unit of the National Public Health Institute in Helsinki,
Finland. "Because of this correlation, it will be important for the
control of mealtime glucose spikes to be a goal in diabetes management."
In healthy adults, the pancreas produces an early burst of insulin to
metabolise the extra glucose following a meal. This early insulin
response is the body's first defense against mealtime glucose spikes and
post-meal hyperglycaemia. In contrast, in people with type 2 diabetes, a
primary defect is the loss of early insulin secretion, ultimately
resulting in mealtime glucose spikes. Because these spikes are not felt
by the patient, they are a hidden threat already in the early stages of
type 2 diabetes.
In the study presented here, Prof. Tuomilehto and colleagues from
Finland and the Netherlands conducted multivariate analyses of data from
1,412 men and 1,276 women enrolled in three different diabetes clinical
trials. The analyses assessed the relative value of three glucose
variables - HbA1c, FPG and 2h-BG, measured alone and in combination - as
predictors for all-cause mortality.
A total of 256 deaths were observed in men and 98 deaths occurred among
women, and all three variables were associated with increased mortality
when assessed individually.
Whereas neither FPG nor HbA1c added statistically significant
information to the 2hr-BG regression model, the addition of 2h-BG to the
models for either of the other variables (FPG and HbA1c) significantly
improved the ability of the models to predict risk of death.
The superiority of 2h-BG as a predictor of mortality was also
demonstrated in a model assessing the relative risk for all three
variables simultaneously.
"This study firmly establishes two-hour blood glucose as a predictor for
mortality in type 2 diabetes," Dr. Tuomilehto concluded. "While HbA1c is
a good indicator of a long-term glycemia, it fails to mark the mealtime
glucose excursions that have many acute effects deleterious to the
cardiovascular system. The data highlight the importance of monitoring
post-meal glucose levels, as well as the need for treatment regimens
that specifically target mealtime hyperglycaemia and restore an early
insulin response."
Jennifer