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Researcher says diabetes guidelines should change - lower blood sugar needed to avoid heart disease

Released: Wednesday, December 21, 2005

A Pennington Biomedical Research Center (PBRC) researcher and diabetes expert believes that physicians with diabetic patients should aim for much lower levels of blood glucose than current guidelines suggest. He believes the current recommendations for blood sugar levels are not low enough to avoid a major complication of diabetes: heart disease.

Citing research published in this month's issue of the New England Journal of Medicine (NEJM), PBRC researcher William Cefalu, M.D., says that if the medical community believes long-term control of blood sugar levels can reduce the risk of cardiovascular disease, then "a reassessment of our clinical goals may be in order."

The work, to be published December 22, shows that more aggressive control of blood sugar levels, by use of a more intensive insulin regimen, appears to help avoid long-term cardiovascular disease. Cefalu made his remarks in an editorial in the same issue of the NEJM.

Currently, physicians counsel their patients with Type 1 (also called juvenile diabetes) and Type 2 (often called adult-onset diabetes) to maintain adequate long-term blood glucose control by achieving an A1c test of 7 percent, which is suggested by the American Diabetes Association. The A1c test is a simple test widely used by physicians during normal office visits to determine blood sugar levels. It measures the amount of blood sugar attached to hemoglobin, a protein found in red blood cells. A normal level is considered to be around 6 percent. Cefalu believes the medical community should rethink this number in light of the newly published findings that reveal long-term, more intensive control of blood sugar levels lead to far less cardiovascular disease.

Cefalu also states that because effects on the cardiovascular system are seen in younger individuals with Type 1 diabetes compared to non-diabetic individuals, the suggested blood sugar levels for juveniles should be revised downward as well from the current guidelines of 8 percent for ages 6 through 12 and 7.5 percent for ages 13 through 19.

Cefalu acknowledges that these would be very difficult goals to reach in that many physicians - and patients - currently struggle to meet the existing guidelines. He states, however, to ignore the data could continue to lead to avoidable cases of heart disease.

"The medical community needs better means, different strategies, and a different mind-set," Cefalu said," if we hope to improve and maintain glycemic [blood sugar] control in patients with Type 1 diabetes and minimize side effects."

The Pennington Biomedical Research Center is a campus of the Louisiana State University System and conducts both clinical and basic research. It is the largest academically based nutrition research center in the world, with the greatest number of obesity researchers on faculty. The Center's nearly 600 employees occupy several buildings on the 234-acre campus.

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The Pennington Biomedical Research Center is at the forefront of medical discovery as it relates to understanding the causes of obesity, diabetes, cardiovascular disease, cancer and dementia. Itis a campus of the Louisiana State University System and conducts basic, clinical and population research. The research enterprise at the Center includes approximately 80 faculty and more than 25 post-doctoral fellows who comprise a network of 50 laboratories supported by lab technicians, nurses, dieticians, and support personnel, and 19 highly specialized core service facilities.  The Center's more than 500 employees perform research activities in state-of-the-art facilities on the 234-acre campus located in Baton Rouge, Louisiana.