Don't forget low-carb diets for diabetes
Regarding Dr Malcolm Kendrick's article on aggressive blood glucose monitoring, according to the ACCORD study it is harmful, and according to the ADVANCE study it probably isn't.
There is, however, more to consider than this. How we go about reducing blood sugars in patients with diabetes is the real issue.
There are known adverse cardiovascular side-effects from some of the drugs used to lower blood sugars. Sulphonylureas increase cardiac mortality, rosiglitazone may increase cardiac events, and if insulin causes hypoglycaemia, as it sometimes does, then hypoglycaemic cardiac arrythmias and sudden death can occur.
Microvascular and macrovascular risks start to increase slowly from an HbA1c greater than 4.8%. Intuitively, you would therefore expect a reduction in these events with normalisation of blood sugars. Such normalisation can occur quite easily in type 1 and type 2 diabetes by restriction of the amount and kind of carbohydrate in the diet.
Replacing refined carbohydrates with low glycaemic vegetables is an easy way to achieve this. Additional protein and fat can be added if necessary for satiety or calories.
Such diets reduce the need for drugs, including insulin and sulphonylureas. In one study patients with type 1 diabetes on diets of 70-90g of carbohydrate a day had a 20-fold reduction in hypoglycaemia compared with those on their usual regimes.
Other studies have shown diabetes patients on low-carbohydrate diets normalise their blood pressure, lipid pattern, weight and insulin sensitivity.
I believe Dr Kendrick is correct when he states that glucotoxicity is not the only problem with diabetes and that adverse effects from pro-inflammatory hormones such as insulin and cytokines should be recognised. Many short- and medium-term studies indicate that carbohydrate restriction can bring health benefits and reduced medication regimes, but when will studies into the long-term effects start?
Dr Katharine Morrison, Ballochmyle Medical Group, Mauchline, Ayrshire