A1c reduction for microvascular, not macro, reduction?

I've just been to an interesting lecture at the local endocrinology
unit.

The guy was mostly lecturing about rosiglitazone & Byetta, but he had
an interesting aside I challenged him on; he said that A1c lead to a
reduction in microvascular events, not macrovascular ones. He was
adamant that there is no literature, including the UKPDS, that linked
a reduction in A1c to macrovascular events (although some data from
the DCCT trends in that direction); everything there is points to
reductions in microvascular. Does this square with what people have
been reading? I was quite impressed by him, so I don't think he's
talking out of his hat.

The other interesting thing he said about Byetta is that getting it in
the UK is back to postcode lottery, irrespective of what NICE are
saying. Suffolk won't allow its prescription; 10 or so other PCTs
will. Beh!

Nicky.
T2 dx 05/04 + underactive thyroid
D&E, 100ug thyroxine
Last A1c 5.6% BMI 25

On Oct 10, 4:10 pm, Nicky <ukc802466...@btconnect.com> wrote:
> I've just been to an interesting lecture at the local endocrinology
> unit.
>
> The guy was mostly lecturing about rosiglitazone & Byetta, but he had
> an interesting aside I challenged him on; he said that A1c lead to a
> reduction in microvascular events, not macrovascular ones. He was
> adamant that there is no literature, including the UKPDS, that linked
> a reduction in A1c to macrovascular events (although some data from
> the DCCT trends in that direction); everything there is points to
> reductions in microvascular. Does this square with what people have
> been reading? I was quite impressed by him, so I don't think he's
> talking out of his hat.

I read with great interest a lot of stuff relevant to T1's and/or
derived from the DCCT, and when I read them I don't see anything
obviously tying macrovascular risk to A1C.

Part of the difficulty for the T1 studies is that most of them focus
on younger T1's (adolescents are very common targets of the studies)
where the macrovascular risks are very low anyway so the statistics
from any one study, even from a really big study like the DCCT, seem
to be inconclusive even if they tend towards saying that more
intensive therapy results in lower macrovascular risk.

As somebody who'se had T1 for so long I think it's kinda sad that T1
studies seem to kind of neglect the fact that although it was once
called "Juvenile Diabetes" most people with it have outgrown being a
juvenile :-).

One of the reviews come out saying that altogether, the trend is
usually that T1 macrovascular diseases are reduced with intensive
therapy, for example http://journal.diabetes.org/diabetes...ent299/B35.asp

Tim.

Nicky wrote:

> The guy was mostly lecturing about rosiglitazone & Byetta, but he had
> an interesting aside I challenged him on; he said that A1c lead to a
> reduction in microvascular events, not macrovascular ones. He was
> adamant that there is no literature, including the UKPDS, that linked
> a reduction in A1c to macrovascular events (although some data from
> the DCCT trends in that direction); everything there is points to
> reductions in microvascular. Does this square with what people have
> been reading? I was quite impressed by him, so I don't think he's
> talking out of his hat.

It's the EPIC-Norfolk study. There's a discussion about halfway down
this page: http://www.phlaunt.com/diabetes/15945839.php

Abstract says A1c is correlated to cardiovascular "events" and "death"
and is "independent of age, body mass index, waist-to-hip ratio,
systolic blood pressure, serum cholesterol concentration, cigarette
smoking, and history of cardiovascular disease."

In short, even if you're a fat, old smoker with bad lipids and a
previous heart attack, controlling bg helps!

--
http://www.ornery-geeks.org/consulting/

"Jackie Patti" <jpatti@ccil.org> wrote in message
news:470d3f21$0$7224$470ef3ce@news.pa.net...
> Nicky wrote:
>
>
> It's the EPIC-Norfolk study. There's a discussion about halfway down this
> page: http://www.phlaunt.com/diabetes/15945839.php
>
But the EPIC-Norfolk study was NOT a study of diabetics. Although of
interest to us.
And as far as I remember it just showed that people with lower A1cs in one
county in eastern England ( Norfolk) had lower rates of CVd than people in
the same county with higher A1cs. I can't remember it showing a reduction in
A1c would actually help ( the damage might already have been done ).
The other point is that Norfolk, in the great scheme of things, is a
relatively small area with a pretty stable gene pool over the last 1500
years. So you cannot rule out a genetic influence in the result.

On Wed, 10 Oct 2007 13:23:51 -0700, Tim Shoppa
<shoppa@trailing-edge.com> wrote:

>Part of the difficulty for the T1 studies is that most of them focus
>on younger T1's (adolescents are very common targets of the studies)
>where the macrovascular risks are very low anyway so the statistics
>from any one study, even from a really big study like the DCCT, seem
>to be inconclusive even if they tend towards saying that more
>intensive therapy results in lower macrovascular risk.

Very true. Anyone doing any longitudinal studies on T1s looking at
this? I know there's plenty of drug studies on T2s.

Nicky.
T2 dx 05/04 + underactive thyroid
D&E, 100ug thyroxine
Last A1c 5.6% BMI 25

On Wed, 10 Oct 2007 17:07:00 -0500, Jackie Patti <jpatti@ccil.org>
wrote:

>It's the EPIC-Norfolk study. There's a discussion about halfway down
>this page: http://www.phlaunt.com/diabetes/15945839.php

Aha! Thanks.

Nicky.
T2 dx 05/04 + underactive thyroid
D&E, 100ug thyroxine
Last A1c 5.6% BMI 25

On Wed, 10 Oct 2007 22:40:26 GMT, "Peter C" <petercy@hotmail.co.uk>
wrote:

>The other point is that Norfolk, in the great scheme of things, is a
>relatively small area with a pretty stable gene pool over the last 1500
>years. So you cannot rule out a genetic influence in the result.
>

Hmmm : ) My sister's in Norfolk, as is at least a couple of posters
here....

Nicky.
T2 dx 05/04 + underactive thyroid
D&E, 100ug thyroxine
Last A1c 5.6% BMI 25

Nicky wrote:

>I've just been to an interesting lecture at the local endocrinology
>unit.
>
>The guy was mostly lecturing about rosiglitazone & Byetta, but he had
>an interesting aside I challenged him on; he said that A1c lead to a
>reduction in microvascular events, not macrovascular ones. He was
>adamant that there is no literature, including the UKPDS, that linked
>a reduction in A1c to macrovascular events (although some data from
>the DCCT trends in that direction); everything there is points to
>reductions in microvascular. Does this square with what people have
>been reading? I was quite impressed by him, so I don't think he's
>talking out of his hat.

You may not forget short-term BG fluctuations, which hardly are
reflected in the HbA1c level and seem to be an independent
macrovascular risk factor possibly more relevant than the long-term BG
mean.

Mike

On 2007-10-12 13:49:58 +0100, Nicky <ukc802466929@btconnect.com> said:

> On Wed, 10 Oct 2007 22:40:26 GMT, "Peter C" <petercy@hotmail.co.uk>
> wrote:
>
>> The other point is that Norfolk, in the great scheme of things, is a
>> relatively small area with a pretty stable gene pool over the last 1500
>> years. So you cannot rule out a genetic influence in the result.
>>
>
> Hmmm : ) My sister's in Norfolk, as is at least a couple of posters
> here....
>
> Nicky.
> T2 dx 05/04 + underactive thyroid
> D&E, 100ug thyroxine
> Last A1c 5.6% BMI 25

Check for webbing between the fingers - that will tell you ;-)

"Nicky" <ukc802466929@btconnect.com> wrote in message
news:r9rug35hg2hbg4pg6ri0p5akgv28vikdhp@4ax.com...
> On Wed, 10 Oct 2007 22:40:26 GMT, "Peter C" <petercy@hotmail.co.uk>
> wrote:
>
>>The other point is that Norfolk, in the great scheme of things, is a
>>relatively small area with a pretty stable gene pool over the last 1500
>>years. So you cannot rule out a genetic influence in the result.
>>
>
> Hmmm : ) My sister's in Norfolk, as is at least a couple of posters
> here....

The genetic mapping of Britain is well under way and showing that many areas
have very stable gene pools dating back a t least a millenium.
For example in relation to Norfolk ...
"Perhaps the most surprising finding is the genetic distiction between
Norfolk and Suffolk , supporting theories of different ancient settlements
of the North and South Angles . The Genetic boundary is ( amazingly ) the
countly line and seems to exactly match the change in the local dialect .
The study which was principally directed at understanding the country's
health problems showed the higher frequency of blood group A in this
area to be associated with a higher incidence of Stomach cancer.
Similar associations were made in the other "enclaves " .
For instance in the Orkney Islands ( Norse Y Chromosones ) there is a
higher incidence of the B
Blood Group and the HLA B7 gene - associated with auto-immune diseases
such as rheumatoid arthritis . They also have the highest incidence of
multiple sclerosis ."

In alt.support.diabetes Peter C <petercy@hotmail.co.uk> wrote:

> "Nicky" <ukc802466929@btconnect.com> wrote in message
> news:r9rug35hg2hbg4pg6ri0p5akgv28vikdhp@4ax.com...
>> On Wed, 10 Oct 2007 22:40:26 GMT, "Peter C" <petercy@hotmail.co.uk>
>> wrote:
>>
>>>The other point is that Norfolk, in the great scheme of things, is a
>>>relatively small area with a pretty stable gene pool over the last 1500
>>>years. So you cannot rule out a genetic influence in the result.
>>>
>>
>> Hmmm : ) My sister's in Norfolk, as is at least a couple of posters
>> here....

> The genetic mapping of Britain is well under way and showing that many areas
> have very stable gene pools dating back a t least a millenium.
> For example in relation to Norfolk ...
> "Perhaps the most surprising finding is the genetic distiction between
> Norfolk and Suffolk , supporting theories of different ancient settlements
> of the North and South Angles . The Genetic boundary is ( amazingly ) the
> countly line and seems to exactly match the change in the local dialect .
> The study which was principally directed at understanding the country's
> health problems showed the higher frequency of blood group A in this
> area to be associated with a higher incidence of Stomach cancer.
> Similar associations were made in the other "enclaves " .
> For instance in the Orkney Islands ( Norse Y Chromosones ) there is a
> higher incidence of the B
> Blood Group and the HLA B7 gene - associated with auto-immune diseases
> such as rheumatoid arthritis . They also have the highest incidence of
> multiple sclerosis ."

What I found very interesting was how stable the gene pools are in
some little coastal villages. One good indicator of that is the little
pockets of Spanish genes (and Spanish looking people) you can find in
places where one of the galleons of the Spanish Armada was wrecked. In
1588 :-)

--
Chris Malcolm cam@infirmatics.ed.ac.uk DoD #205
IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]