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	<title>Comments on: Tight diabetes guidelines and the &quot;glitazone&quot; problem</title>
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		<title>By: Christine-Megan</title>
		<link>http://www.kevinmd.com/blog/2007/09/tight-diabetes-guidelines-and-glitazone.html/comment-page-1#comment-80005</link>
		<dc:creator>Christine-Megan</dc:creator>
		<pubDate>Fri, 14 Sep 2007 01:37:00 +0000</pubDate>
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		<description>Gah, I couldn&#039;t agree less!  &lt;br/&gt;&lt;br/&gt;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&#039;t want to do this.  And certainly many patients don&#039;t.  So instead we get sub-optimal control leading to heart disease on a drug that leads to heart disease.&lt;br/&gt;&lt;br/&gt;I do NOT think the a1c targets should be lessened.  7% is the ADA&#039;s goal.  The AACE recommends 6.5%.  8% is an average glucose of nearly 210.  Research I&#039;ve seen suggests that damage occurs over 150.  Some feel it happens even lower.&lt;br/&gt;&lt;br/&gt;So maybe we&#039;ll cut the risk of side effects from OA&#039;s, we&#039;ll just kill their kidneys, eyes, and peripheral circulation, and possibly still end up with heart disease.&lt;br/&gt;&lt;br/&gt;Bad plan imho.</description>
		<content:encoded><![CDATA[<p>Gah, I couldn&#8217;t agree less!  </p>
<p>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&#8217;t want to do this.  And certainly many patients don&#8217;t.  So instead we get sub-optimal control leading to heart disease on a drug that leads to heart disease.</p>
<p>I do NOT think the a1c targets should be lessened.  7% is the ADA&#8217;s goal.  The AACE recommends 6.5%.  8% is an average glucose of nearly 210.  Research I&#8217;ve seen suggests that damage occurs over 150.  Some feel it happens even lower.</p>
<p>So maybe we&#8217;ll cut the risk of side effects from OA&#8217;s, we&#8217;ll just kill their kidneys, eyes, and peripheral circulation, and possibly still end up with heart disease.</p>
<p>Bad plan imho.</p>
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