Lower A1c's Increase Death Risk?

Is that what the cessation of the ACCORD Study, announced today is
really saying? Or just in high risk patients? or...?
Morris
************************************************** *******
MSNBC.com
Major diabetes trial halted after deaths
257 patients died after intense therapy to lower blood sugar, NIH
reports
The Associated Press
updated 7:34 a.m. PT, Wed., Feb. 6, 2008

WASHINGTON - An unexpected number of deaths among patients receiving
intense therapy to lower their blood sugar forced the National
Institutes of Health to abruptly cut short part of a major study on
diabetes and heart disease.

The therapy was aimed at reducing to normal levels the blood sugar of
type 2 diabetics at especially high risk of heart attack and stroke.
There were 257 deaths among people receiving intense diabetes
treatment, compared with 203 in the standard treatment group, NIH's
National Heart Lung and Blood Institute said.

More than 18 million Americans have diabetes, with type 2 the most
common form.

Last fall the Food and Drug Administration added new warnings to the
label of the popular diabetes drug Avandia, listing concerns about
heart ailments. However, in Wednesday's announcement NHLBI officials
stressed that they have been unable to link the increased deaths in
the study to any drug, including Avandia.

Some 10,251 people were enrolled in the Action to Control
Cardiovascular Risk in Diabetes study, with an average participation
time of four years.

The participants were in groups receiving three types of treatment,
intensive lowering of blood sugar, lowering blood pressure or reducing
cholesterol.

"A thorough review of the data shows that the medical treatment
strategy of intensively reducing blood sugar below current clinical
guidelines causes harm in these especially high-risk patients with
type 2 diabetes," said Dr. Elizabeth G. Nabel, director of the
institute.

"Though we have stopped this part of the trial, we will continue to
care for these participants, who now will receive the less-intensive
standard treatment. In addition, we will continue to monitor the
health of all participants, seek the underlying causes for this
finding, and carry on with other important research within ACCORD,"
she said in a statement.

Multiple risk factors
The study focuses on treatments for adults with type 2 diabetes, the
most common form, who are at especially high risk for heart disease,
meaning they had at least two risk factors, which include high blood
pressure, high cholesterol, obesity and smoking.

Dr. William Friedewald, professor of Public Health and Medicine at
Columbia University, and chairman of the ACCORD Steering Committee,
said that there were "about 10 percent fewer nonfatal cardiovascular
events such as heart attacks in the intensive treatment group compared
to the standard treatment group. However, it appeared that, if a heart
attack did occur, it was more likely to be fatal. In addition, the
intensive treatment group had more unexpected sudden deaths, even
without a clear heart attack."

The action was recommended by an independent advisory group of experts
in diabetes, heart disease, epidemiology, patient care, biostatistics,
medical ethics and clinical trial design that has been monitoring
ACCORD since it began.

Participants will continue to receive blood sugar treatment from their
study clinicians until the planned trial conclusion in June 2009.

Nabel stressed that diabetes patients should not change their
treatment without consulting their doctor. The American Diabetes
Association agreed and said it continues to encourage control of blood
sugar in treatment of diabetes.

NHLBI said the intensive treatment group had a target blood sugar goal
of less than 6 percent, which is similar to blood sugar levels in
adults without diabetes. The standard treatment group aimed for a
target similar to what is achieved, on average, by those with diabetes
in the United States, of 7 to 7.9 percent.

(c) 2008 The Associated Press. All rights reserved. This material may
not be published, broadcast, rewritten or redistributed.

"morris" <morrisolder@comcast.net> wrote in message
news:3b1bdf96-6870-4661-93cc-67f6806bd73b@1g2000hsl.googlegroups.com...
> Is that what the cessation of the ACCORD Study, announced today is
> really saying? Or just in high risk patients? or...?
> Morris
> ************************************************** *******
> MSNBC.com
> Major diabetes trial halted after deaths
> 257 patients died after intense therapy to lower blood sugar, NIH
> reports
> The Associated Press
> updated 7:34 a.m. PT, Wed., Feb. 6, 2008
>
> WASHINGTON - An unexpected number of deaths among patients receiving
> intense therapy to lower their blood sugar forced the National
> Institutes of Health to abruptly cut short part of a major study on
> diabetes and heart disease.
>
> The therapy was aimed at reducing to normal levels the blood sugar of
> type 2 diabetics at especially high risk of heart attack and stroke.
> There were 257 deaths among people receiving intense diabetes
> treatment, compared with 203 in the standard treatment group, NIH's
> National Heart Lung and Blood Institute said.
>
> More than 18 million Americans have diabetes, with type 2 the most
> common form.
>
> Last fall the Food and Drug Administration added new warnings to the
> label of the popular diabetes drug Avandia, listing concerns about
> heart ailments. However, in Wednesday's announcement NHLBI officials
> stressed that they have been unable to link the increased deaths in
> the study to any drug, including Avandia.
>
> Some 10,251 people were enrolled in the Action to Control
> Cardiovascular Risk in Diabetes study, with an average participation
> time of four years.
>
> The participants were in groups receiving three types of treatment,
> intensive lowering of blood sugar, lowering blood pressure or reducing
> cholesterol.
>
> "A thorough review of the data shows that the medical treatment
> strategy of intensively reducing blood sugar below current clinical
> guidelines causes harm in these especially high-risk patients with
> type 2 diabetes," said Dr. Elizabeth G. Nabel, director of the
> institute.
>
> "Though we have stopped this part of the trial, we will continue to
> care for these participants, who now will receive the less-intensive
> standard treatment. In addition, we will continue to monitor the
> health of all participants, seek the underlying causes for this
> finding, and carry on with other important research within ACCORD,"
> she said in a statement.
>
> Multiple risk factors
> The study focuses on treatments for adults with type 2 diabetes, the
> most common form, who are at especially high risk for heart disease,
> meaning they had at least two risk factors, which include high blood
> pressure, high cholesterol, obesity and smoking.
>
> Dr. William Friedewald, professor of Public Health and Medicine at
> Columbia University, and chairman of the ACCORD Steering Committee,
> said that there were "about 10 percent fewer nonfatal cardiovascular
> events such as heart attacks in the intensive treatment group compared
> to the standard treatment group. However, it appeared that, if a heart
> attack did occur, it was more likely to be fatal. In addition, the
> intensive treatment group had more unexpected sudden deaths, even
> without a clear heart attack."
>
> The action was recommended by an independent advisory group of experts
> in diabetes, heart disease, epidemiology, patient care, biostatistics,
> medical ethics and clinical trial design that has been monitoring
> ACCORD since it began.
>
> Participants will continue to receive blood sugar treatment from their
> study clinicians until the planned trial conclusion in June 2009.
>
> Nabel stressed that diabetes patients should not change their
> treatment without consulting their doctor. The American Diabetes
> Association agreed and said it continues to encourage control of blood
> sugar in treatment of diabetes.
>
> NHLBI said the intensive treatment group had a target blood sugar goal
> of less than 6 percent, which is similar to blood sugar levels in
> adults without diabetes. The standard treatment group aimed for a
> target similar to what is achieved, on average, by those with diabetes
> in the United States, of 7 to 7.9 percent.
>
> (c) 2008 The Associated Press. All rights reserved. This material may
> not be published, broadcast, rewritten or redistributed.

I'd like to know what "intense therapy" is in this study. Drugs? Diet?
Exercise? All ? This is the key to knowing what this means. I don't
think it was lower a1c that was the problem, it must have been whatever
means were used to get lower a1c.

cheers

Paul

"morris" <morrisolder@comcast.net> wrote in message
news:3b1bdf96-6870-4661-93cc-67f6806bd73b@1g2000hsl.googlegroups.com...
> Is that what the cessation of the ACCORD Study, announced today is
> really saying? Or just in high risk patients? or...?
> Morris
> ************************************************** *******

Hi morris,
thanks for the link

This is not for speed readers ; I managed to find the whole study and the
protocol > 100 pages

Here are my 2 cents :
1) In the ACCORD study there were ONLY patients that had MORE THAN 1 problem
: obesity , smoking , heart , T2D

2) The patients in the intensive treatment group had to lower their A1c with
medication and medical nutrition therapy.See below for the enormous amount
of medication.The medical nutrition theraphy followed the ADA diet
recommandations for a healthy diet

3) So they started with lots of whole grains and carbohydrates in their
diets

4) Thus they were put on insulin , raising their insulin resistance ,
icreasing their BMI

5) The carbohydrates in their diet raised their LDL levels and thus their
symvastin and other drugs medication were increased

5) Within 3 months most of the patients used : a cholesterol drug , insulin
and 1 or 2 other T2D drugs !!!!

This study clearly demonstrates the failure of the current treatment
paradigma's for T2D : eat "healthy" and use all necessary drugs to
compensate for the complications.

I would like to see another group that were given the skills , education
etc to lower their A1c by diet & exercise while minimizing (instead of
maximizing) their drug intake

Maybe Gary Taubes has an opinion on this

I'm not making this up read the original statements by the authors here :
============================================
The news release :
http://www.eurekalert.org/pub_releas...-ibs020608.php

They were also enrolled in one of two other ACCORD randomized clinical
trials examining effects of treatments for blood pressure or blood lipids;
those study components will continue. Participants had been followed for 2
years to 7 years at the time the intensive blood sugar control treatment was
stopped.

For both the intensive and standard treatment groups, study clinicians could
use all major classes of diabetes medications available: metformin,
thiazolidinediones (TZDs, primarily rosiglitazone), insulins, sulfonylureas,
exanatide, and acarbose.

"Because of the recent concerns with rosiglitazone, our extensive analysis
included a specific review to determine whether there was any link between
this particular medication and the increased deaths. We found no link," said
William T. Friedewald, M.D., ACCORD Steering Committee Chair and Clinical
Professor of Medicine and Public Health at Columbia University.

The Accord website:
http://www.accordtrial.org/public/index.cfm

The Accord Protocol:
http://www.accordtrial.org/public/pr...2005-05-11.pdf
Page 54 :
For example, within 6 months of randomization, most intensive group
participants will likely be on 3 or more injections of insulin per day in
addition to 2 or 3 oral agents.

Page 59 :
Self-titration of Anti-hyperglycemic Therapy
Standard therapy participants will be provided with simple algorithms to
allow them to self-titrate their oral therapy or insulin to avoid
hypoglycemia. They will also be instructed to call the clinic if they are
recording frequent low SMBG values (see Table 3.2); if they have any episode
of severe hypoglycemia; if they are experiencing frequent episodes of
symptomatic hypoglycemia (>1/week); or if they have any symptoms of
hyperglycemia. In these instances, therapy can be adjusted.

Page 61 :
Glycemia Medications Available Within ACCORD
The following classes of antihyperglycemic drugs are available within
ACCORD:
a) biguanides (e.g., metformin)
b) secretagogues (e.g., sulfonylureas such as glimepiride and meglitinides
such as repaglinide)
c) thiazolidinediones (e.g., rosiglitazone)
d) alpha-glucosidase inhibitors (e.g., acarbose)
e) insulins (e.g., NPH, ultralente, glargine, aspart, regular).

Page 78 :
Medical Nutrition Therapy
Medical Nutrition Therapy (MNT) consists of weight control and dietary
modification. The American Diabetes Association (ADA) position statement on
"Nutrition Recommendations and Principles for People with Diabetes Mellitus"
reports that "medical nutrition therapy is integral to total diabetes care
and an essential component of successful diabetes management" (ADA 2000a).

Thanks again morris
Gys

"GysdeJongh" <jongh711@planet.nl> wrote in message
news:47aa3ada$0$25480$ba620dc5@text.nova.planet.nl ...
> "morris" <morrisolder@comcast.net> wrote in message
> news:3b1bdf96-6870-4661-93cc-67f6806bd73b@1g2000hsl.googlegroups.com...
>> Is that what the cessation of the ACCORD Study, announced today is
>> really saying? Or just in high risk patients? or...?
>> Morris
>> ************************************************** *******
>
> Hi morris,
> thanks for the link
>
> This is not for speed readers ; I managed to find the whole study and the
> protocol > 100 pages
>
> Here are my 2 cents :
> 1) In the ACCORD study there were ONLY patients that had MORE THAN 1
> problem : obesity , smoking , heart , T2D
>
> 2) The patients in the intensive treatment group had to lower their A1c
> with medication and medical nutrition therapy.See below for the enormous
> amount of medication.The medical nutrition theraphy followed the ADA diet
> recommandations for a healthy diet
>
> 3) So they started with lots of whole grains and carbohydrates in their
> diets
>
> 4) Thus they were put on insulin , raising their insulin resistance ,
> icreasing their BMI
>
> 5) The carbohydrates in their diet raised their LDL levels and thus their
> symvastin and other drugs medication were increased
>
> 5) Within 3 months most of the patients used : a cholesterol drug ,
> insulin and 1 or 2 other T2D drugs !!!!
>
> This study clearly demonstrates the failure of the current treatment
> paradigma's for T2D : eat "healthy" and use all necessary drugs to
> compensate for the complications.
>
> I would like to see another group that were given the skills , education
> etc to lower their A1c by diet & exercise while minimizing (instead of
> maximizing) their drug intake
>
> Maybe Gary Taubes has an opinion on this
>
> I'm not making this up read the original statements by the authors here :
> ============================================
> The news release :
> http://www.eurekalert.org/pub_releas...-ibs020608.php
>
> They were also enrolled in one of two other ACCORD randomized clinical
> trials examining effects of treatments for blood pressure or blood lipids;
> those study components will continue. Participants had been followed for 2
> years to 7 years at the time the intensive blood sugar control treatment
> was stopped.
>
> For both the intensive and standard treatment groups, study clinicians
> could use all major classes of diabetes medications available: metformin,
> thiazolidinediones (TZDs, primarily rosiglitazone), insulins,
> sulfonylureas, exanatide, and acarbose.
>
> "Because of the recent concerns with rosiglitazone, our extensive analysis
> included a specific review to determine whether there was any link between
> this particular medication and the increased deaths. We found no link,"
> said William T. Friedewald, M.D., ACCORD Steering Committee Chair and
> Clinical Professor of Medicine and Public Health at Columbia University.
>
> The Accord website:
> http://www.accordtrial.org/public/index.cfm
>
> The Accord Protocol:
> http://www.accordtrial.org/public/pr...2005-05-11.pdf
> Page 54 :
> For example, within 6 months of randomization, most intensive group
> participants will likely be on 3 or more injections of insulin per day in
> addition to 2 or 3 oral agents.
>
> Page 59 :
> Self-titration of Anti-hyperglycemic Therapy
> Standard therapy participants will be provided with simple algorithms to
> allow them to self-titrate their oral therapy or insulin to avoid
> hypoglycemia. They will also be instructed to call the clinic if they are
> recording frequent low SMBG values (see Table 3.2); if they have any
> episode of severe hypoglycemia; if they are experiencing frequent episodes
> of symptomatic hypoglycemia (>1/week); or if they have any symptoms of
> hyperglycemia. In these instances, therapy can be adjusted.
>
> Page 61 :
> Glycemia Medications Available Within ACCORD
> The following classes of antihyperglycemic drugs are available within
> ACCORD:
> a) biguanides (e.g., metformin)
> b) secretagogues (e.g., sulfonylureas such as glimepiride and meglitinides
> such as repaglinide)
> c) thiazolidinediones (e.g., rosiglitazone)
> d) alpha-glucosidase inhibitors (e.g., acarbose)
> e) insulins (e.g., NPH, ultralente, glargine, aspart, regular).
>
> Page 78 :
> Medical Nutrition Therapy
> Medical Nutrition Therapy (MNT) consists of weight control and dietary
> modification. The American Diabetes Association (ADA) position statement
> on "Nutrition Recommendations and Principles for People with Diabetes
> Mellitus" reports that "medical nutrition therapy is integral to total
> diabetes care and an essential component of successful diabetes
> management" (ADA 2000a).
>
> Thanks again morris
> Gys

.... and thanks to you Gys for sifting through all that, well, information.

cheers

Paul

morris wrote:

> Is that what the cessation of the ACCORD Study, announced today is
> really saying? Or just in high risk patients? or...?

It is interesting since many T2s have therapies to control the following:

"The participants were in groups receiving three types of treatment,
intensive lowering of blood sugar, lowering blood pressure or reducing
cholesterol."

If someone has type 2 diabetes and the metabolic syndrome, they are
likely to have therapies for each of the above components. However, the
newsrelease did not attribute the cause to the TZD Advandia which is not
usually a initial T2 therapy. Also only about 7% of the T2DMs reach the
goals for all three control goals.

The therapies Gys cited with his extract cover the whole spectrum of T2
therapies.

Frank

On Wed, 6 Feb 2008 23:55:25 +0100, "GysdeJongh"
<jongh711@planet.nl> wrote:

>"morris" <morrisolder@comcast.net> wrote in message
>news:3b1bdf96-6870-4661-93cc-67f6806bd73b@1g2000hsl.googlegroups.com...
>> Is that what the cessation of the ACCORD Study, announced today is
>> really saying? Or just in high risk patients? or...?
>> Morris
>> ************************************************** *******
>
>Hi morris,
>thanks for the link
>
>This is not for speed readers ; I managed to find the whole study and the
>protocol > 100 pages
>
>Here are my 2 cents :
>1) In the ACCORD study there were ONLY patients that had MORE THAN 1 problem
>: obesity , smoking , heart , T2D
>
>2) The patients in the intensive treatment group had to lower their A1c with
>medication and medical nutrition therapy.See below for the enormous amount
>of medication.The medical nutrition theraphy followed the ADA diet
>recommandations for a healthy diet
>
>3) So they started with lots of whole grains and carbohydrates in their
>diets
>
>4) Thus they were put on insulin , raising their insulin resistance ,
>icreasing their BMI
>
>5) The carbohydrates in their diet raised their LDL levels and thus their
>symvastin and other drugs medication were increased
>
>5) Within 3 months most of the patients used : a cholesterol drug , insulin
>and 1 or 2 other T2D drugs !!!!
>
>This study clearly demonstrates the failure of the current treatment
>paradigma's for T2D : eat "healthy" and use all necessary drugs to
>compensate for the complications.
>
> I would like to see another group that were given the skills , education
>etc to lower their A1c by diet & exercise while minimizing (instead of
>maximizing) their drug intake
>
>Maybe Gary Taubes has an opinion on this
>
>I'm not making this up read the original statements by the authors here :
>============================================
>The news release :
>http://www.eurekalert.org/pub_releas...-ibs020608.php
>
>They were also enrolled in one of two other ACCORD randomized clinical
>trials examining effects of treatments for blood pressure or blood lipids;
>those study components will continue. Participants had been followed for 2
>years to 7 years at the time the intensive blood sugar control treatment was
>stopped.
>
>For both the intensive and standard treatment groups, study clinicians could
>use all major classes of diabetes medications available: metformin,
>thiazolidinediones (TZDs, primarily rosiglitazone), insulins, sulfonylureas,
>exanatide, and acarbose.
>
>"Because of the recent concerns with rosiglitazone, our extensive analysis
>included a specific review to determine whether there was any link between
>this particular medication and the increased deaths. We found no link," said
>William T. Friedewald, M.D., ACCORD Steering Committee Chair and Clinical
>Professor of Medicine and Public Health at Columbia University.
>
>The Accord website:
>http://www.accordtrial.org/public/index.cfm
>
>The Accord Protocol:
>http://www.accordtrial.org/public/pr...2005-05-11.pdf
>Page 54 :
>For example, within 6 months of randomization, most intensive group
>participants will likely be on 3 or more injections of insulin per day in
>addition to 2 or 3 oral agents.
>
>Page 59 :
>Self-titration of Anti-hyperglycemic Therapy
>Standard therapy participants will be provided with simple algorithms to
>allow them to self-titrate their oral therapy or insulin to avoid
>hypoglycemia. They will also be instructed to call the clinic if they are
>recording frequent low SMBG values (see Table 3.2); if they have any episode
>of severe hypoglycemia; if they are experiencing frequent episodes of
>symptomatic hypoglycemia (>1/week); or if they have any symptoms of
>hyperglycemia. In these instances, therapy can be adjusted.
>
>Page 61 :
>Glycemia Medications Available Within ACCORD
>The following classes of antihyperglycemic drugs are available within
>ACCORD:
>a) biguanides (e.g., metformin)
>b) secretagogues (e.g., sulfonylureas such as glimepiride and meglitinides
>such as repaglinide)
>c) thiazolidinediones (e.g., rosiglitazone)
>d) alpha-glucosidase inhibitors (e.g., acarbose)
>e) insulins (e.g., NPH, ultralente, glargine, aspart, regular).
>
>Page 78 :
>Medical Nutrition Therapy
>Medical Nutrition Therapy (MNT) consists of weight control and dietary
>modification. The American Diabetes Association (ADA) position statement on
>"Nutrition Recommendations and Principles for People with Diabetes Mellitus"
>reports that "medical nutrition therapy is integral to total diabetes care
>and an essential component of successful diabetes management" (ADA 2000a).
>
>Thanks again morris
>Gys
>
Thaks Gys. Those extracts help a lot. I'm still ploughing
through it trying to prepare an acceptable response on this
for an ADA forum thread.

If we are reading the same documents, this is the overall
version of "Methods" for the intensive glycemic management
section. Possibly the most important aspect is that after
"In addition to lifestyle approaches," no further effort
appears to be made to review or modify those lifestyle
approaches. "Intensive" from that point on is defined by
adding medications; whatever works to drive down A1c and
BG's without changing lifestyles further.

http://www.accordtrial.org/web/publi...AJC%200607.pdf
P36 et seq

I've added some para breaks for clarity. Where odd symbols
appear, they usually mean "less than or equal to" but
context should show it.

"Methods
Details regarding the overall design of ACCORD are described
elsewhere in this supplement.14 All ACCORD participants are
provided with education regarding diet and lifestyle,
glucose monitoring and therapy, and the avoidance and
treatment of hypoglycemia. They are also provided with
antidiabetic medications from a formulary of drugs, as well
as glucose-monitoring equipment.

The ACCORD formulary contains the following drugs,
representing several classes of antihyperglycemic agents:
glimepiride (a sulfonylurea), repaglinide
(a rapid-acting secretagogue), metformin (a biguanide),
rosiglitazone (a thiazolidinedione), acarbose (an
_-glucosidase inhibitor), glargine, neutral protamine
Hagedorn and premixed insulins (longer-acting insulins), and
aspart and regular insulin (shorter-acting insulins).

Participants randomly allocated to the intensive treatment
group are scheduled for monthly visits for the first 4
months and bimonthly visits thereafter, with _1 extra visit
or between-visits phone call. Participants in the standard
glycemic control group are seen at 1 month and then every
2-4 months depending on whether they are also allocated to
the intensive blood pressure control arm of ACCORD, as
described in the report on the trial's overall design
elsewhere in this supplement.14 Additional interactions with
either group are scheduled at the discretion of the clinical
site. HbA1c levels are measured at a central laboratory
every 4 months, and the results are promptly reported back
to clinical sites and to the central database. A Bayer DCA
2000 point-of-care measurement device (Bayer AG, Leverkusen,
Germany) is also available at each site to immediately
estimate participants' HbA1c results when indicated (see the
following discussion).

As noted in the inclusion criteria, described in this
supplement, 14 all participants' HbA1c levels must be
documented to be _7.5% before randomization. Thus, glycemic
interventions are adjusted with the aim of reducing all of
the intensive-group participants' HbA1c levels to _6% and to
either maintain or reduce standard-group participants' HbA1c
levels at 7.0%-7.9%. Investigators and research staff
members are all provided with guidelines regarding diabetes
care and are given flexibility to individualize
interventions (including lifestyle approaches, behavioral
therapies, and self-titration and the adjustment of any of
the glucoselowering drugs) needed to achieve the glycemic
targets of the group to which each participant has been
allocated.

Thus, ACCORD is a trial in which 2 different treatment
policies or strategies (with differing HbA1c targets and not
mandated differential medication use) are being compared.

Intensive glycemic control: In addition to lifestyle
approaches, the pharmacologic antihyperglycemic regimen of
intensive-group participants is initially adjusted so that
_2 classes of agents are provided. As noted in Table 3, the
dosage of _1 class is to be increased, or an agent of
another class is to be added at each visit, whenever (1)
the central laboratory-measured or point-of-care HbA1c level
is _6%, (2) _50% of self-monitored premeal capillary glucose
readings are _5.6 mmol/L (100 mg/dL), or (3) _50% of
postmeal capillary glucose readings are _7.8 mmol/L (140
mg/dL). When a new agent is added, previous therapies are
continued unless there is a specific reason not to do so.
Medications are reduced or withdrawn only because of side
effects, severe hypoglycemia,13 or contraindications. All
combinations of drugs are permitted.

Several tools have been developed to promote the
intensification of therapy. These are available to
investigators, nurses, dietitians, and research staff
members at all sites and include

(1) Web-based patient management tools that allow
investigators to review the latest HbA1c level and drug
regimen of each participant at their sites in comparison
with other participants at the sites;

(2) automated e-mails when a participant's HbA1c level
requires corrective action;

(3) dynamic, Web-based reports that allow investigators to
view the median achieved HbA1c levels and the frequency and
nature of drugs used at their sites relative to other sites
in ACCORD;

(4) weekly e-mailed tips to all sites suggesting methods to
intensify therapy that are prepared by expert ACCORD
clinicians and staff members;

(5) the regular distribution of achieved HbA1c levels in the
intensive group at each site;

(6) regular audit and feedback in which the achieved HbA1c
levels and antidiabetic regimens used at each site are
reviewed by a network expert who is external to the site;
and

(7) annual training meetings that include glycemic
management workshops and lectures.

Finally, point-of-care HbA1c measurements using the Bayer
DCA 2000 are used at each visit to immediately inform
changes in antihyperglycemic therapy; such an approach has
been shown to lead to better glycemic control than awaiting
central laboratory HbA1c levels.15

Standard glycemic control: The antihyperglycemic regimen
of standard-group participants is adjusted to reach and
maintain an HbA1c level of 7.0%-7.9%. Lifestyle and/or
pharmacologic therapy is intensified whenever HbA1c is _8%,
and pharmacologic therapy is relaxed if a participant is
experiencing problems with hypoglycemia or other side
effects. Moreover, antihyperglycemic drug therapies that
promote hypoglycemic episodes (ie, insulin and insulin
secretagogues) are reduced or withdrawn if HbA1c levels
persistently decrease to _7% in patients who are
experiencing hypoglycemia (summarized in Tables 3 and 4)."


Cheers, Alan, T2, Australia.
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
--
http://loraldiabetes.blogspot.com
Latest: LuckyKat

Jefferson wrote:
> morris wrote:
>
>> Is that what the cessation of the ACCORD Study, announced today is
>> really saying? Or just in high risk patients? or...?
>
>
> It is interesting since many T2s have therapies to control the following:
>
> "The participants were in groups receiving three types of treatment,
> intensive lowering of blood sugar, lowering blood pressure or reducing
> cholesterol."
>
> If someone has type 2 diabetes and the metabolic syndrome, they are
> likely to have therapies for each of the above components. However, the
> newsrelease did not attribute the cause to the TZD Advandia which is not
> usually a initial T2 therapy. Also only about 7% of the T2DMs reach the
> goals for all three control goals.
>
> The therapies Gys cited with his extract cover the whole spectrum of T2
> therapies.
>
> Frank
Cardiometabolic Risk in the Spotlight: Which Therapies Should Take
Center Stage? - http://www.medscape.com/viewprogram/8506 or
http://tinyurl.com/2ea8re

1. Spotlight on Risks: Obesity Sidney C Smith, Jr, MDAvailable As:
Slides/Video | Audio
2. Spotlight on Risks: Dyslipidemia Daniel J Rader, MDAvailable As:
Slides/Video | Audio
3. Spotlight on Risks: Diabetes Richard W Nesto, MDAvailable As:
Slides/Video | Audio
4. Spotlight on Risk: Biomarkers Jorge Plutzky, MDAvailable As:
Slides/Video | Audio
5. Spotlight on Mood DisordersCharles B Nemeroff, MD, PhDAvailable
As: Slides/Video | Audio
6. Center Stage in Cardiometabolic Risk Uberto Pagotto, MD,
PhDAvailable As: Slides/Video | Audio

Frank

On Wed, 6 Feb 2008 13:45:09 -0800 (PST), morris
<morrisolder@comcast.net> wrote:

>WASHINGTON - An unexpected number of deaths among patients receiving
>intense therapy to lower their blood sugar forced the National
>Institutes of Health to abruptly cut short part of a major study on
>diabetes and heart disease.

G'day G'day Folks,

I find it fascinating how a results lead to conclusions.

The patients receiving intensive therapy were more likely to die.
Yet it is a lower A1c that is blamed. Obviously it is misdirection
but why.

The headline (conclusion) doesn't match the research result.

What happens with people who manage a lower A1c WITHOUT intensive
therapy? Surely they have a lower death rate. In the extreme case
non-diabetics have a lower A1c and a lower death rate and are more
likely to survive a heart attack if they have one.

Put simply it isn't the lower A1c that is a cause, it is some aspect
of the intensive therapy. It doesn't appear to be a particular
medication as if one is worse than another rather something common to
the treatment of ALL the participants receiving the intensive
treatment.

IMHO I believe Gys is most likely close to the nub of the matter.

A more accurate conclusion might well be that the standard high carb
diets with intensive medication should be discontinued as they raise
the death rate,

To me the situation as similar to those analgesics like Vioxx that had
to be withdrawn when it was found they also increased the rate of
fatal heart attacks.

Best wishes,
--
Quentin Grady ^ ^ /
New Zealand, >#,#< [
/ \ /\
"... and the blind dog was leading."

http://homepages.paradise.net.nz/quentin

Did they distinguish between outcomes by the three high risk factors ?
I would have thought the following heirarchy applied irrespective of
treatment regimes ...
1. high bp, smoking, high chols
2. smoking, high bp
3. smoking , high chols
4. high bp, high chols

Hopefully they distributed the 4 risk factor groups evenly between the three
treatment divisions. It might not make a great deal of sense otherwise e.g.
if they had a higher ratio of smokers in the intensive treatment group.
A bit of a poke in the eye for the six per cent club though ;-)

On Thu, 07 Feb 2008 12:50:13 GMT, "Peter C" <petercy@hotmail.co.uk>
wrote:
>A bit of a poke in the eye for the six per cent club though ;-)
>

You volunteering to go higher and see how well you feel on it?!

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

In news:tfadnaX-Gp58szfanZ2dnUVZ_quhnZ2d@comcast.com,
Paul L typed on Wed, 6 Feb 2008 15:03:46 -0700:
> I'd like to know what "intense therapy" is in this study. Drugs?
> Diet? Exercise? All ? This is the key to knowing what this means. I
> don't think it was lower a1c that was the problem, it must have
> been whatever means were used to get lower a1c.

You don't think lower A1c was the problem? Think about it for a second.
Lower A1c means lower available fuel for your cells. Thus a lot of cells
starve and die! Which increases the chances that the patient dies too if
too many cells die. So how are you thinking that lower A1c is somehow
healthier? I am so curious?

--
Bill
DX 1992 (ignored till 4/2007)
A1c 4/2007 10.5
A1c 6/2007 7.4
A1c 8/2007 6.8

On Thu, 7 Feb 2008 18:09:00 -0600, "BillW50"
<BillW50@aol.kom> wrote:

>In news:tfadnaX-Gp58szfanZ2dnUVZ_quhnZ2d@comcast.com,
>Paul L typed on Wed, 6 Feb 2008 15:03:46 -0700:
>> I'd like to know what "intense therapy" is in this study. Drugs?
>> Diet? Exercise? All ? This is the key to knowing what this means. I
>> don't think it was lower a1c that was the problem, it must have
>> been whatever means were used to get lower a1c.
>
>You don't think lower A1c was the problem? Think about it for a second.
>Lower A1c means lower available fuel for your cells. Thus a lot of cells
>starve and die! Which increases the chances that the patient dies too if
>too many cells die. So how are you thinking that lower A1c is somehow
>healthier? I am so curious?

You're serious?

Start here, then do a little checking for more on Google
Scholar: http://www.bmj.com/cgi/content/full/322/7277/15

Cheers, Alan, T2, Australia.
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
--
http://loraldiabetes.blogspot.com
Latest: LuckyKat

BillW50 <BillW50@aol.kom> wrote:
: In news:tfadnaX-Gp58szfanZ2dnUVZ_quhnZ2d@comcast.com,
: Paul L typed on Wed, 6 Feb 2008 15:03:46 -0700:
: > I'd like to know what "intense therapy" is in this study. Drugs?
: > Diet? Exercise? All ? This is the key to knowing what this means. I
: > don't think it was lower a1c that was the problem, it must have
: > been whatever means were used to get lower a1c.

: You don't think lower A1c was the problem? Think about it for a second.
: Lower A1c means lower available fuel for your cells. Thus a lot of cells
: starve and die! Which increases the chances that the patient dies too if
: too many cells die. So how are you thinking that lower A1c is somehow
: healthier? I am so curious?

: --
: Bill

Lower Aic does not mean less fuel. there is always the fat availe eiher
from the diet or from that stored in fat cells , which is more eadily
available if the bgs and the A1cs are lower.

Wendy

Jefferson wrote:

>> It is interesting since many T2s have therapies to control the following:
>>
>> "The participants were in groups receiving three types of treatment,
>> intensive lowering of blood sugar, lowering blood pressure or reducing
>> cholesterol."
>>
>> If someone has type 2 diabetes and the metabolic syndrome, they are
>> likely to have therapies for each of the above components. However,
>> the newsrelease did not attribute the cause to the TZD Advandia which
>> is not usually a initial T2 therapy. Also only about 7% of the T2DMs
>> reach the goals for all three control goals.
>>

In well controlled T2DMs the post-prandial state is the biggest
contributor to HbA1c. It is not so easy to get an a1c under 6% without
fairly good post-prandial glucose control. Monnier et al have done
research on this topic and I have posted on it a few times in the past.
Also "What Is the Real Contribution of Fasting Plasma Glucose and
Postprandial Glucose in Predicting HbA1c and Overall Blood Glucose
Control?" - http://care.diabetesjournals.org/cgi...ull/24/11/2011

"Recent studies indicate that about one-third of American adults and
two-thirds of CAD patients have abnormal glucose homeostasis.[6,7] A
significant proportion of these at-risk individuals will have a fasting
glucose level in the nondiabetic range (<126 mg/dl) but would show
hyperglycemia diagnostic of impaired glucose tolerance (>140 mg/dl) or
diabetes (>200 mg/dl) after an oral glucose tolerance test or a meal.

Continuous linear direct relationships exist between glucose levels
after a glucose challenge and the risks of both CV death and all-cause
mortality.[8] At only 80 mg/dl the CV risk of post-prandial or
post-challenge glycemia begins to increase; by 140 mg/dl, the point at
which we traditionally only begin to classify patients as glucose
intolerant or pre-diabetic, the risk is already increased by 58%[9,10].

(see) Figure 1. Post-Challenge Glucose and Coronary Atherosclerosis
Progression.

Patients with normal glucose tolerance who had a post-prandial glucose
level of <87 mg/dl had coronary regression. The remaining patients had
coronary progression in proportion to the increase in post-prandial
glucose. Data from Mellen et al. [10]." Dietary Strategies for Improving
Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health -
http://www.medscape.com/viewarticle/569077_print

Reference #8 - Cavalot F, Petrelli A, Traversa M, et al. Post-prandial
blood glucose is a stronger predictor of cardiovascular events than
fasting blood glucose in type 2 diabetes mellitus. J Clin Endocrinol
Metab 2006;91:813–9.

The outcomes in the Accord trial seems contradictory to many other
studies.

What is the real answer? The inclusion criteria for intensive therapy
may have the answer. The progression of cardiovascular disease was
advanced in part of the intensive therapy group.

"2.1.a Inclusion Criteria
6. At high risk of CVD events, defined as: A. Presence of clinical
cardiovascular disease. • previous myocardial infarction (MI) • previous
stroke • History of coronary revascularization (e.g., coronary artery
bypass graft surgery, stent placement, percutaneous transluminal
coronary angioplasty, or laser atherectomy) • History of carotid or
peripheral revascularization (e.g., carotid endarterectomy, lower
extremity atherosclerotic disease atherectomy, repair of abdominal aorta
aneurysm, femoral or popliteal bypass) • angina with ischemic changes
(resting ECG), ECG changes on a graded exercise test (GXT), or positive
cardiac imaging study or B. If no clinical cardiovascular disease,
evidence in the last 2 years suggesting a high likelihood of
cardiovascular disease. Specifically, the presence of one of the
following: • Microalbuminuria • Ankle brachial index < 0.9 (by simple
palpation) • LVH by ECG or ECHO • > 50% stenosis of a coronary, carotid,
or lower extremity artery or C. The presence of at least 2 of the
following factors that increase CVD risk: • On lipid lowering medication
or untreated LDL-C >130 mg/dl (3.38 mmol/l) • Low HDL-C (< 40 mg/dl
(1.04 mmol/l) for men and < 50 mg/dl (1.29 mmol/l) for women) • On BP
lowering medication or untreated SBP >140 mm Hg or DBP > 95 mm Hg. •
Current cigarette smoking • Body mass index > 32 kg/m2 Note: Category A
represents secondary prevention participants. Categories B and C
together represent primary prevention participants."
http://www.accordtrial.org/public/pr...2005-05-11.pdf

Frank

In news:t4cnq39a0qlhjdbu4pe2so547889biv12i@4ax.com,
Alan S typed on Fri, 08 Feb 2008 12:31:03 +1100:
> On Thu, 7 Feb 2008 18:09:00 -0600, "BillW50"
> <BillW50@aol.kom> wrote:
>
>> In news:tfadnaX-Gp58szfanZ2dnUVZ_quhnZ2d@comcast.com,
>> Paul L typed on Wed, 6 Feb 2008 15:03:46 -0700:
>>> I'd like to know what "intense therapy" is in this study. Drugs?
>>> Diet? Exercise? All ? This is the key to knowing what this
>>> means. I don't think it was lower a1c that was the problem, it must
>>> have
>>> been whatever means were used to get lower a1c.
>>
>> You don't think lower A1c was the problem? Think about it for a
>> second. Lower A1c means lower available fuel for your cells. Thus a
>> lot of cells starve and die! Which increases the chances that the
>> patient dies too if too many cells die. So how are you thinking that
>> lower A1c is somehow healthier? I am so curious?
>
> You're serious?
>
> Start here, then do a little checking for more on Google
> Scholar: http://www.bmj.com/cgi/content/full/322/7277/15

I can't read that Alan! I'm an electrical engineer and it is all Greek
to me. Explain in laymen terms how starving the patient by lowering A1c
is somehow healthier? If I starve my goldfish it dies! If I starve my
dog, it dies! If I starve my children (if I had any and I don't have any
dogs either) they die! Are you trying to tell me through some magic of
mumbo-jumbo it isn't true?

--
Bill
DX 1992 (ignored till 4/2007)
A1c 4/2007 10.5
A1c 6/2007 7.4
A1c 8/2007 6.8

In news:fogcks$hpp$2@reader2.panix.com,
W. Baker typed on Fri, 8 Feb 2008 01:52:28 +0000 (UTC):
> BillW50 <BillW50@aol.kom> wrote:
>> In news:tfadnaX-Gp58szfanZ2dnUVZ_quhnZ2d@comcast.com,
>> Paul L typed on Wed, 6 Feb 2008 15:03:46 -0700:
>>> I'd like to know what "intense therapy" is in this study. Drugs?
>>> Diet? Exercise? All ? This is the key to knowing what this
>>> means. I don't think it was lower a1c that was the problem, it must
>>> have
>>> been whatever means were used to get lower a1c.
>
>> You don't think lower A1c was the problem? Think about it for a
>> second. Lower A1c means lower available fuel for your cells. Thus a
>> lot of cells starve and die! Which increases the chances that the
>> patient dies too if too many cells die. So how are you thinking that
>> lower A1c is somehow healthier? I am so curious?
>
> Lower Aic does not mean less fuel. there is always the fat availe
> eiher from the diet or from that stored in fat cells , which is more
> eadily available if the bgs and the A1cs are lower.

That is what I thought too Wendy! But I was told that turning fat into
energy creates a toxin called ketones. Which in laymen terms means it is
a killer. And second of all, if one's BG is dropping fast, converting
fat into energy doesn't happen instantly from what I heard. As it takes
time. And in that time it makes sense that some cells will starve to
death anyway. Do this over and over again and it is no wonder patients
are dying faster.

--
Bill
DX 1992 (ignored till 4/2007)
A1c 4/2007 10.5
A1c 6/2007 7.4
A1c 8/2007 6.8

On Thu, 7 Feb 2008 20:04:45 -0600, "BillW50"
<BillW50@aol.kom> wrote:

>In news:t4cnq39a0qlhjdbu4pe2so547889biv12i@4ax.com,
>Alan S typed on Fri, 08 Feb 2008 12:31:03 +1100:
>> On Thu, 7 Feb 2008 18:09:00 -0600, "BillW50"
>> <BillW50@aol.kom> wrote:
>>
>>> In news:tfadnaX-Gp58szfanZ2dnUVZ_quhnZ2d@comcast.com,
>>> Paul L typed on Wed, 6 Feb 2008 15:03:46 -0700:
>>>> I'd like to know what "intense therapy" is in this study. Drugs?
>>>> Diet? Exercise? All ? This is the key to knowing what this
>>>> means. I don't think it was lower a1c that was the problem, it must
>>>> have
>>>> been whatever means were used to get lower a1c.
>>>
>>> You don't think lower A1c was the problem? Think about it for a
>>> second. Lower A1c means lower available fuel for your cells. Thus a
>>> lot of cells starve and die! Which increases the chances that the
>>> patient dies too if too many cells die. So how are you thinking that
>>> lower A1c is somehow healthier? I am so curious?
>>
>> You're serious?
>>
>> Start here, then do a little checking for more on Google
>> Scholar: http://www.bmj.com/cgi/content/full/322/7277/15
>
>I can't read that Alan! I'm an electrical engineer and it is all Greek
>to me. Explain in laymen terms how starving the patient by lowering A1c
>is somehow healthier? If I starve my goldfish it dies! If I starve my
>dog, it dies! If I starve my children (if I had any and I don't have any
>dogs either) they die! Are you trying to tell me through some magic of
>mumbo-jumbo it isn't true?

Who is talking about starving? That would be A1c=0. Read my
sig: "Everything in Moderation". I agree that you can go too
low. What we disagree on is the definition of that point.

Now, to help define when it starts to get too high, here is
my layman's precis of that paper:
http://www.bmj.com/cgi/content/full/322/7277/15

"HbA1c was continuously related to subsequent all cause,
cardiovascular, and ischaemic heart disease mortality
through the whole population distribution, with lowest rates
in those with HbA1c concentrations below 5%."

Means lowest rates of death occur with A1c less than 5%.

"An increase of 1% in HbA1c was associated with a 28%
(P<0.002) increase in risk of death independent of age,
blood pressure, serum cholesterol, body mass index, and
cigarette smoking habit"

Means that, starting at 5%, your risk of death increases by
28% for each 1% rise in A1c.

I reckon that is pretty darn clear in both medicspeak and
layspeak.

Cheers, Alan, T2, Australia.
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
--
http://loraldiabetes.blogspot.com
Latest: LuckyKat

"BillW50" <BillW50@aol.kom> wrote in message
news:47abb8c9$0$1342$834e42db@reader.greatnowhere. com...
> In news:t4cnq39a0qlhjdbu4pe2so547889biv12i@4ax.com,
> Alan S typed on Fri, 08 Feb 2008 12:31:03 +1100:
>> On Thu, 7 Feb 2008 18:09:00 -0600, "BillW50"
>> <BillW50@aol.kom> wrote:
>>
>>> In news:tfadnaX-Gp58szfanZ2dnUVZ_quhnZ2d@comcast.com,
>>> Paul L typed on Wed, 6 Feb 2008 15:03:46 -0700:
>>>> I'd like to know what "intense therapy" is in this study. Drugs?
>>>> Diet? Exercise? All ? This is the key to knowing what this
>>>> means. I don't think it was lower a1c that was the problem, it must
>>>> have
>>>> been whatever means were used to get lower a1c.
>>>
>>> You don't think lower A1c was the problem? Think about it for a
>>> second. Lower A1c means lower available fuel for your cells. Thus a
>>> lot of cells starve and die! Which increases the chances that the
>>> patient dies too if too many cells die. So how are you thinking that
>>> lower A1c is somehow healthier? I am so curious?
>>
>> You're serious?
>>
>> Start here, then do a little checking for more on Google
>> Scholar: http://www.bmj.com/cgi/content/full/322/7277/15
>
> I can't read that Alan! I'm an electrical engineer and it is all Greek to
> me. Explain in laymen terms how starving the patient by lowering A1c is
> somehow healthier? If I starve my goldfish it dies! If I starve my dog, it
> dies! If I starve my children (if I had any and I don't have any dogs
> either) they die! Are you trying to tell me through some magic of
> mumbo-jumbo it isn't true?

Nobody is telling you to starve!

In newspQqj.4679$G94.4095@trndny02,
Julie Bove typed on Fri, 08 Feb 2008 03:56:04 GMT:
> "BillW50" <BillW50@aol.kom> wrote in message
> news:47abb8c9$0$1342$834e42db@reader.greatnowhere. com...
>> In news:t4cnq39a0qlhjdbu4pe2so547889biv12i@4ax.com,
>> Alan S typed on Fri, 08 Feb 2008 12:31:03 +1100:
>>> On Thu, 7 Feb 2008 18:09:00 -0600, "BillW50"
>>> <BillW50@aol.kom> wrote:
>>>
>>>> In news:tfadnaX-Gp58szfanZ2dnUVZ_quhnZ2d@comcast.com,
>>>> Paul L typed on Wed, 6 Feb 2008 15:03:46 -0700:
>>>>> I'd like to know what "intense therapy" is in this study. Drugs?
>>>>> Diet? Exercise? All ? This is the key to knowing what this
>>>>> means. I don't think it was lower a1c that was the problem, it
>>>>> must have
>>>>> been whatever means were used to get lower a1c.
>>>>
>>>> You don't think lower A1c was the problem? Think about it for a
>>>> second. Lower A1c means lower available fuel for your cells. Thus a
>>>> lot of cells starve and die! Which increases the chances that the
>>>> patient dies too if too many cells die. So how are you thinking
>>>> that lower A1c is somehow healthier? I am so curious?
>>>
>>> You're serious?
>>>
>>> Start here, then do a little checking for more on Google
>>> Scholar: http://www.bmj.com/cgi/content/full/322/7277/15
>>
>> I can't read that Alan! I'm an electrical engineer and it is all
>> Greek to me. Explain in laymen terms how starving the patient by
>> lowering A1c is somehow healthier? If I starve my goldfish it dies!
>> If I starve my dog, it dies! If I starve my children (if I had any
>> and I don't have any dogs either) they die! Are you trying to tell
>> me through some magic of mumbo-jumbo it isn't true?
>
> Nobody is telling you to starve!

Really? How the *hell* am I suppose to get my A1c down to 5 when I am
*only* having 3 glasses of milk a day and a bowl of raw iceberg lettuce
and it still isn't doing it (that is like 300 calories a day, almost all
from the milk)? Worse, my BG is in the 30's at least 3 times a week and
I like it! Personally I think I am sick and I need not to listen to
people and to get more normal. And I think some of you have to redo your
thinking!

--
Bill
DX 1992 (ignored till 4/2007)
A1c 4/2007 10.5
A1c 6/2007 7.4
A1c 8/2007 6.8

"BillW50" <BillW50@aol.kom> wrote in message
news:47abe1d0$0$1349$834e42db@reader.greatnowhere. com...
> In newspQqj.4679$G94.4095@trndny02,
> Julie Bove typed on Fri, 08 Feb 2008 03:56:04 GMT:
>> "BillW50" <BillW50@aol.kom> wrote in message
>> news:47abb8c9$0$1342$834e42db@reader.greatnowhere. com...
>>> In news:t4cnq39a0qlhjdbu4pe2so547889biv12i@4ax.com,
>>> Alan S typed on Fri, 08 Feb 2008 12:31:03 +1100:
>>>> On Thu, 7 Feb 2008 18:09:00 -0600, "BillW50"
>>>> <BillW50@aol.kom> wrote:
>>>>
>>>>> In news:tfadnaX-Gp58szfanZ2dnUVZ_quhnZ2d@comcast.com,
>>>>> Paul L typed on Wed, 6 Feb 2008 15:03:46 -0700:
>>>>>> I'd like to know what "intense therapy" is in this study. Drugs?
>>>>>> Diet? Exercise? All ? This is the key to knowing what this
>>>>>> means. I don't think it was lower a1c that was the problem, it
>>>>>> must have
>>>>>> been whatever means were used to get lower a1c.
>>>>>
>>>>> You don't think lower A1c was the problem? Think about it for a
>>>>> second. Lower A1c means lower available fuel for your cells. Thus a
>>>>> lot of cells starve and die! Which increases the chances that the
>>>>> patient dies too if too many cells die. So how are you thinking
>>>>> that lower A1c is somehow healthier? I am so curious?
>>>>
>>>> You're serious?
>>>>
>>>> Start here, then do a little checking for more on Google
>>>> Scholar: http://www.bmj.com/cgi/content/full/322/7277/15
>>>
>>> I can't read that Alan! I'm an electrical engineer and it is all
>>> Greek to me. Explain in laymen terms how starving the patient by
>>> lowering A1c is somehow healthier? If I starve my goldfish it dies!
>>> If I starve my dog, it dies! If I starve my children (if I had any
>>> and I don't have any dogs either) they die! Are you trying to tell
>>> me through some magic of mumbo-jumbo it isn't true?
>>
>> Nobody is telling you to starve!
>
> Really? How the *hell* am I suppose to get my A1c down to 5 when I am
> *only* having 3 glasses of milk a day and a bowl of raw iceberg lettuce
> and it still isn't doing it (that is like 300 calories a day, almost all
> from the milk)? Worse, my BG is in the 30's at least 3 times a week and I
> like it! Personally I think I am sick and I need not to listen to people
> and to get more normal. And I think some of you have to redo your
> thinking!

3 glasses of milk? Why milk? That's loaded with carbs. Where is your fat
and protein? And why are you eating iceberg lettuce? There's no
nutritional value in that! Sounds like you need to see a dietician who will
give you a balanced diet!

In alt.support.diabetes on Thu, 7 Feb 2008 22:59:57 -0600 in Msg.#
<47abe1d0$0$1349$834e42db@reader.greatnowhere.com> , "BillW50"
<BillW50@aol.kom> wrote:

> Really? How the *hell* am I suppose to get my A1c down to 5 when I am
> *only* having 3 glasses of milk a day and a bowl of raw iceberg lettuce
> and it still isn't doing it (that is like 300 calories a day, almost all
> from the milk)? Worse, my BG is in the 30's at least 3 times a week and
> I like it! Personally I think I am sick and I need not to listen to
> people and to get more normal. And I think some of you have to redo your
> thinking!

How did you end up with that being your regular way of eating?

--
DonnaB shallotpeel, T2 since June 06, USA

"Msitukane wagema na ulevi ungalipo. - Do not abuse palm-wine tappers if you
wish for drunkenness." - Swahili proverb [kanga]

In news:f3snq3lse81pkpvh9b2fdgc2m3vtgcsm9c@4ax.com,
DonnaB shallotpeel typed on Fri, 08 Feb 2008 01:04:47 -0500:
> In alt.support.diabetes on Thu, 7 Feb 2008 22:59:57 -0600 in Msg.#
> <47abe1d0$0$1349$834e42db@reader.greatnowhere.com> , "BillW50"
> <BillW50@aol.kom> wrote:
>
>> Really? How the *hell* am I suppose to get my A1c down to 5 when I am
>> *only* having 3 glasses of milk a day and a bowl of raw iceberg
>> lettuce and it still isn't doing it (that is like 300 calories a
>> day, almost all from the milk)? Worse, my BG is in the 30's at least
>> 3 times a week and I like it! Personally I think I am sick and I
>> need not to listen to people and to get more normal. And I think
>> some of you have to redo your thinking!
>
> How did you end up with that being your regular way of eating?

Trying to get my A1c down like a good boy! And they are going to kill me
if I keep listening to them. After all, the result of the last study
shows this is true and they had to stop it. Haven't you been listening?

--
Bill
DX 1992 (ignored till 4/2007)
A1c 4/2007 10.5
A1c 6/2007 7.4
A1c 8/2007 6.8

In news:HSRqj.13836$FW3.7404@trndny03,
Julie Bove typed on Fri, 08 Feb 2008 05:35:35 GMT:
> "BillW50" <BillW50@aol.kom> wrote in message
> news:47abe1d0$0$1349$834e42db@reader.greatnowhere. com...
>> In newspQqj.4679$G94.4095@trndny02,
>> Julie Bove typed on Fri, 08 Feb 2008 03:56:04 GMT:
>>> "BillW50" <BillW50@aol.kom> wrote in message
>>> news:47abb8c9$0$1342$834e42db@reader.greatnowhere. com...
>>>> In news:t4cnq39a0qlhjdbu4pe2so547889biv12i@4ax.com,
>>>> Alan S typed on Fri, 08 Feb 2008 12:31:03 +1100:
>>>>> On Thu, 7 Feb 2008 18:09:00 -0600, "BillW50"
>>>>> <BillW50@aol.kom> wrote:
>>>>>
>>>>>> In news:tfadnaX-Gp58szfanZ2dnUVZ_quhnZ2d@comcast.com,
>>>>>> Paul L typed on Wed, 6 Feb 2008 15:03:46 -0700:
>>>>>>> I'd like to know what "intense therapy" is in this study.
>>>>>>> Drugs? Diet? Exercise? All ? This is the key to knowing what
>>>>>>