Professor Umesh Kumar

Professor Umesh Kumar
I am trying to answer your query by doing a self-study from Google. You will agree that Technology and Medical science advancement is a continuing process. In India there are hardly any funds available for R & D. USA is the country where Medical Advancement is a continuing process.
Nobel Prize winners in USA till 2015 were 360 compared to India’s 11 while the Population of India is 4 times that of USA. This itself will gives you an idea why USA is the No. 1 Country in the World.
The Article of mine you have mentioned is written by a Medical Professor of Harvard. He has himself mentioned that “When I was in medical school, and for many years thereafter, “lower is better” was what doctors believed.” “We knew that people with diabetes could develop severe, even fatal, complications if their blood sugar got very high. Plus, we had powerful blood-sugar-lowering treatments available.

On the other hand, there was a limit to “lower is better.” Too much of a good thing could be a bad thing:
Over treatment could push blood sugars too low — dangerously low. Sustained very low blood sugar can produce confusion, coma and death. So we measured blood sugars frequently, with the goal of having blood sugar as low as it could go without causing bothersome symptoms.”

Being Prepared for Hypoglycemia

People who use insulin or take an oral diabetes medication that can cause low blood glucose should always be prepared to prevent and treat low blood glucose by
• learning what can trigger low blood glucose levels
• having their blood glucose meter available to test glucose levels; frequent testing may be critical for those with hypoglycemia unawareness, particularly before driving a car or engaging in any hazardous activity
• always having several servings of quick-fix foods or drinks handy
• wearing a medical identification bracelet or necklace
• planning what to do if they develop severe hypoglycemia
• telling their family, friends, and coworkers about the symptoms of hypoglycemia and how they can help if needed

Hyperglycemia

Hyperglycemia can lead to diabetic ketoacidosis
It is important to attend to hyperglycemia since it can lead to a dangerous complication known as ketoacidosis that can result in coma and even death. Ketoacidosis rarely occurs in type 2 diabetes, typically occurring in cases of type 1 diabetes.
High levels of glucose in the blood mean that insufficient levels of glucose are available to cells for their energy needs. As a result, the body resorts to breaking down fat so that energy is derived from fatty acids. This breakdown produces ketones, leading to higher acidity of the blood.
Diabetic ketoacidosis requires urgent medical attention and, alongside hyperglycemia and its symptoms, is signaled by:
 Nausea or vomiting
 Abdominal pain
 A fruity smell on the breath
 Drowsiness or confusion
 Hyperventilation
 Dehydration
 Loss of consciousness.
Hospital treatment of ketoacidosis includes the administering of intravenous fluids and insulin.2

What are ACCORD, ADVANCE, and the VADT?

First, some background: ACCORD, ADVANCE, and the VADT were three large clinical trials that compared the rates of heart disease in patients receiving either “intensive” diabetes treatment (targeting near-normal average blood glucose levels - A1c closer to 6%), or “conventional” diabetes treatment (targeting somewhat higher blood glucose levels - A1c closer to 7.5%).

ACCORD was designed to test 10,000 people in North America and Canada over eight years, half with an A1c goal of 6%, the other half with a 7.5% goal in the diabetes part of the trial.

ADVANCE tested 11,1400 people over six years in Australia of whom half had a 6.5% A1c goal and half targeted 7%.

VADT included almost 2,000 veterans in the US with an A1c goal of less than 6.0% for half of the participants, and 8.0-9.0% for the other half. These studies were designed to test the theory that extremely tight control of BG would help reduce heart disease.
As a reminder, the A1c is a measure of average blood glucose. An A1c of 7.0% is equivalent to an estimated average blood glucose level of 154 mg/dl (8.5 mmol/l), whereas an A1c of 6.0% is equivalent to an average blood glucose level of 126 mg/dl (7 mmol/l).
Roughly two-thirds of people with type 2 diabetes die from heart disease, a much higher rate than in the general population. As such, researchers for these three studies wanted to see if reducing blood sugar to near-normal levels would reduce the risk of heart disease.
The three trials differed in the precise blood glucose levels targeted, as well as in their patient populations. Patients were mostly over 60 years old with a long duration of type 2 diabetes. Thus, the results may not be relevant to people less than 60 years of age, people with type 1 diabetes, or people with either newly diagnosed or well-managed type 2 diabetes. If you have type 2 diabetes and are at high risk of heart disease, or have had a heart attack, then these results are more likely to relate to you.
Contrary to many researchers’ expectations, none of the three trials showed a clear benefit of tight glucose control on heart disease risk over the study periods. In ADVANCE, which lasted five years, and the VADT, which lasted seven and a half years, the rate of heart attacks, stroke, and heart disease was similar between the intensive and standard glucose arms of the studies. Even though both studies went to completion, some doctors believe that a longer study would have shown greater benefits of intensive glucose control on heart disease.

In contrast, the intensive glucose control arm of the ACCORD study was famously discontinued in February, long before its expected completion date. This happened after a committee responsible for overseeing the study found that the intensive glucose control arm had significantly more deaths than the standard control arm (257 versus 203)
May be Professor Umesh Kumar that these trials and study gave an idea of the course to follow:
We knew that people with diabetes could develop severe, even fatal, complications if their blood sugar got very high. Plus, we had powerful blood-sugar-lowering treatments available.

On the other hand, there was a limit to “lower is better.” Too much of a good thing could be a bad thing:
Over treatment could push blood sugars too low — dangerously low. Sustained very low blood sugar can produce confusion, coma and death. So we measured blood sugars frequently, with the goal of having blood sugar as low as it could go without causing bothersome symptoms.
Too much of a good thing might have been fatal. One possible reason is that the low blood sugar may have triggered a dangerous heart rhythm.

So, while lowering blood sugar with treatment definitely improves health, there are limits. "Today I and many other doctors do not treat blood sugar as intensively as we used to." more