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Wednesday 26th October 2016

New approach to type 2 diabetes

23rd February 2008

Insulin treatment, exercise and a low-carbohydrate diet have for many years been regarded as the practical way to treat type 2 diabetes.


From the days that American researcher Elliot Joslin first advocated this in the 1960s, other studies have vindicated his approach, notably the United Kingdom Prospective Diabetes Study of 1998.

Using A1C as a reliable indicator of blood-glucose levels, it found healthy people usually have A1C levels of 4-6%, while above 9.5% is dangerous. Those whose A1C levels were reduced by treatment to around 7% suffered fewer heart attacks and strokes than those held at around 8%.

However, sceptics feared what was being treated was a symptom and not a cause.

To test this, the National Heart, Lung and Blood Institute (NHLBI) in America established the ACCORD study, dividing 10,000 people into three tracks and subdividing a specific group with the aim of reducing A1C levels to 7% in one section and 6% in another.

But the NHLBI has now had to suspend that specific track after it emerged that the 6% group suffered more fatal heart attacks than the 7% sector.

With the results still not published, there has been speculation over the nature of the problem.

However, The Economist reports the cause was not drug interactions, specific drugs or a bias in the patient sample.

ACCORD has suggested that the sceptics were right – the underlying cause of diabetes needs to be addressed as part of high blood pressure, heart disease and obesity.

What is emerging is a picture that while drugs-based treatments are not wrong, it is better to not need them in the first place. Healthy eating is the key.


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