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Diabetics should monitor their blood sugar more often than previously thought

Quality Improvement Monitor, September 29, 2004

People with Type I and Type II diabetes should monitor their blood sugar levels more than the usual twice daily to ensure that levels are not more than 150 milligrams per deciliter for sustained periods, according to a study published online in the Annals of Internal Medicine September 21.

After pooling and re-analyzing the data from 13 previously published studies involving nearly 10,000 people from North America and Europe with Type I or Type II diabetes, the researchers concluded that for every 1% rise in glycated hemoglobin levels, there was an 18% increase in the risk of developing large-vessel cardiovascular disease among people with Type II diabetes.

For people with juvenile onset or Type I diabetes, the researchers found a similar increased risk of 15% for every 1% rise in levels of glycated hemoglobin; however, as there were fewer studies involving people with Type I diabetes, this risk estimate is not as reliable as the estimate for Type II.

"The relationship between blood sugar levels in people with diabetes and whether this increases their risk of developing heart disease has remained unclear until now, despite many different studies about specific types of cardiovascular problems," says the study's senior author, endocrinologist Sherita Golden, MD, MHS, assistant professor of medicine and epidemiology, at The Johns Hopkins University School of Medicine and Bloomberg School of Public Health.

Flashback: A landmark British study in 1998 first nailed down the direct link between control of blood sugar levels in people with Type II diabetes and risk of developing small-vessel disease, where excessive levels of blood sugar can have serious long-term consequences, including blindness, kidney damage, and peripheral nerve disease.

However, this study was largely considered inconclusive by the medical community because it lacked statistically significant results, and despite results that showed a 16% decrease in large-vessel cardiovascular disease in people whose blood sugar levels were aggressively treated. Hence, the U.K. study did not fully clarify the need for or frequency of monitoring for prevention of large-vessel disease.

Related news brief: In another recent study published in the Journal of the American Medical Association, researchers found that women who increase their intake or consume higher amounts of sugar-sweetened beverages have a greater magnitude of weight gain and a higher risk of developing Type II diabetes.

-- Wendy Johnson
wjohnson@hcpro.com

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