Robert Centor suggests that the zeal to lower hemoglobin A1c’s below 7 is partly responsible for the Avandia controversy:
His point, on which I concur, states that our efforts to lower HgbA1c stimulated our willingness to try another drug to reach the magic number. Perhaps the zeal for lowering HgbA1c to below 7 stimulates us to use a second or third drug. Perhaps if we had a more realistic goal of 8 we would have less’glitazone’ use, and thus fewer bad outcomes.
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Gah, I couldn’t agree less!
Instead of using 3 oral medications and still having sub-optimal results, I think the focus should be on adding insulin sooner. But I think many physicians don’t want to do this. And certainly many patients don’t. So instead we get sub-optimal control leading to heart disease on a drug that leads to heart disease.
I do NOT think the a1c targets should be lessened. 7% is the ADA’s goal. The AACE recommends 6.5%. 8% is an average glucose of nearly 210. Research I’ve seen suggests that damage occurs over 150. Some feel it happens even lower.
So maybe we’ll cut the risk of side effects from OA’s, we’ll just kill their kidneys, eyes, and peripheral circulation, and possibly still end up with heart disease.
Bad plan imho.
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