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Re: [IPk] macrovascular complications

I agree with Abigail here, the suggestion that glucose control doesn't
matter in preventing heart disease is incorrect.

The DCCT concentrated on microvascular complicatins because these happen (at
least to a level at which they can be detected and progression monitored)
much more often in type 1. Heart disease is not common in young people, even
with type 1 diabetes, so a short trial will only see a very small number of
events in that category, and will not be able to show a difference even when
it exists.

Instead, to see the effect of high blood glucose on macrovascular disease
risk (that is, heart attack, stroke, and circulation problems), we have to
look at the bigger, more mature population with diabetes, those with type 2.
Like the DCCT, the UKPDS looked at this group over a longer period of 20
years, starting from diagnosis, so just like all of us, they were starting
with 'primary prevention' in other words stopping the problem from
developing when it wasn't already there.

The UKPDS has been analysed in great detail, and many papers have been
published. One of the recent ones picked out glucose control as an
individual risk factor, controlling all the other risk factors like blood
pressure and smoking, and the results of this are very significant. I've
attached both summaries, and the UKPDS paper can be searched out in full at
BMJ.com, but in essence it concludes that a 1% drop in HbA1c reduces the
risk of a heart attack (myocardial infarction) by 14%, and the risk of dying
from a diabetes-related cause by 21%.

While this study was of people with type 2, who are different in a number of
ways, I feel that it still guides us in deciding whether it's worth
controling our blood sugars well or not. The bottom line is, that while as
teenagers we start concentrating entirely on glucose, as our risk of
developing arterial disease rises, we have to start monitoring our other
risk factors as well, not just the depressing ones we can't do anything
about, like being male, from Ireland, having a family history OR having a
murky past (!!), but the ones we CAN change, specifically smoking, BP and

Here's an exercise for anyone over 30. Get hold of the latest figures for
these, and click onto the risk calculator at :


I like this one because it's motivating, it gives 5 and 10 year risk levels,
and shows us what will happen if we redeem ourselves, (and believe me,
no-one is beyond redemption). The HDL refers to one of several lipids
besides cholesterol, but if you don't know yours, enter 1.

One last thing. After you have viewed your risk level, try it again with
diabetes clicked as No, and see what happens.


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