Tight blood sugar control as measured by what is called a surrogate marker (HbA1c <7.0%) does not reduce risk of death overall including death from suffering a heart attack or stroke. Furthermore, it does not reduce the risk of suffering a non-fatal stroke, inflammation of the arteries nor amputation of lower limbs. It may in fact in-crease the risk of heart failure.
Worryingly, in one trial it actually increased death rates (total and heart/stroke related). On the (rather weak) plus side it did appear to reduce the risk of non-fatal heart attacks by just 15%.
None of the available drugs (known as anti-diabetic drugs), which include Metformin and Insulin has clearly been proven in the gold-standard trials (compared against dummy pills) that damage to arteries, small or large, has been reduced.
The authors conclude: Other treatments should be prescribed for patients suffering from type 2 diabetes – including (healthy) nutrition advice, (increased) physical activity and complete cessation of smoking cigarettes.
Are we surprised? No not really. Unless we change our lifestyle behaviour then the number of us suffering diabetes and its complications will continue to climb.
Published: 3 February 2017
Prevention of complications in type 2 diabetes: is drug glucose control evi-dence based?
Rémy Boussageon, Denis Pouchain and Vincent Renard Br J Gen Pract 2017; 67 (655): 85-87. DOI: https://doi.org/10.3399/bjgp17X689317