Monitor Linked to Mobile Device Helps Lower Blood Pressure in Type 2s - Diabetes Health

A monitor attached to a mobile device helps people with type 2 diabetes lower their blood pressure more than simply having a blood pressure monitor available in the home. That's the conclusion of a year-long study conducted by the University Health Network in Toronto, Canada. The study showed that type 2 patients whose blood pressure was actively reported to their doctors via a Bluetooth-enabled device enjoyed lower blood pressure than patients whose readings were not passed on to doctors.

The study looked at 110 adults with type 2 and uncontrolled systolic hypertension-a form of high blood pressure. The control group used a standard home monitor to track their blood pressure readings. The intervention group was equipped with Bluetooth-enabled monitors that automatically transmitted blood pressure readings to each patient's family doctor. Patients using the device who failed to monitor their blood pressure at least once every three days received automated reminders to do so

At the start of the study, the mean daytime blood pressure reading for all participants was 142.7/77.1 mmHg. (The first number is for systolic, the second for diastolic; mmHg stands for millimeters of mercury, an indicator of pressure.) By the end, while there was no change in the control group's numbers, the intervention group saw a decline of 9.1 mmHg in systolic blood pressure and a 4.66 mmHg decline in diastolic.

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Very Interesting topic reported by the BBC. Interestingly I had read reports that indicated that a lower blood glucose level was target to achieve. I think that this adds a bit od 'sense' - the right blood sugar level is what we should aim for. I aim for around 7, but achieve around 7.5


Diabetes sugar 'can go too low'

Diabetes disrupts blood sugar levels
Intense treatment to lower blood sugar in patients with diabetes could prove nearly as harmful as allowing glucose levels to remain high, a study says.
Cardiff researchers looked at nearly 50,000 patients with type 2 diabetes and found the lowest glucose levels linked to a heightened risk of death.
Significant differences in death rates between patients on insulin and those taking tablets are also flagged up.
But there could be various explanations for this, experts noted.
Patients taking insulin-based treatments have been urged not to stop taking their medication as a result of the Cardiff University study, which is published in The Lancet.
Changing treatments
Using data from GPs, the team identified 27,965 patients with type 2 diabetes whose treatment had been intensified to include two oral blood glucose lowering agents - metformin and sulphonylurea.
It is crucial to remember that blood glucose targets should always be agreed by the person with diabetes and their healthcare team according to individual needs and not according to a blanket set of rules
Dr Iain FrameDiabetes UK
A further 20,005 patients who had been moved on to treatment which included insulin were added to the study.
Patients whose HbA1c levels - the proportion of red blood cells with glucose attached to them - were around 7.5%, ran the lowest risk of dying from any cause.
For both groups this risk went up by more than half if levels dropped to 6.4%, the lowest levels recorded. For those with the highest levels the risk of death increased by nearly 80%.
But the risks appeared to be particularly pronounced among those on the insulin-based regimen than those on the combined treatment.
Irrespective of whether their HbA1c levels were low or high, there were 2,834 deaths in the insulin-taking group between 1986 and 2008, nearly 50% more than in the combined group.
'Don't stop'
The authors acknowledged there could be various factors associated with this, such as these being older patients with more health problems, who perhaps had had diabetes for a longer period of time. They also make reference to a possible link between use of insulin and cancer progression that had been reported in a different study.
"Whether intensification of glucose control with insulin therapy alone further heightens risk of death in patients with diabetes needs further investigation and assessment of the overall risk balance," wrote lead author Dr Craig Currie.
"Low and high mean HbA1c values were associated with increased all-cause mortality and cardiac events. If confirmed, diabetes guidelines might need revision to include a minimum HbA1c value."
Dr Iain Frame, head of research at Diabetes UK, described the study as "potentially important" but stressed it had limitations.
"It is not clear what the causes of death were from the results reported. Furthermore, when it comes to the suggestion made in this research that insulin could increase the risk of death, we must consider important factors such as age, the duration of their diabetes and how the participants managed their condition.
"It is crucial to remember that blood glucose targets should always be agreed by the person with diabetes and their healthcare team according to individual needs and not according to a blanket set of rules."
While people would be able to manage their condition for a period with diet, exercise and even tablets, many would eventually have to move on to insulin, he noted.
"We would advise people with type 2 diabetes who use insulin not to stop taking their medication. However, if they are worried about blood glucose targets, they should discuss this with their healthcare team."

Understanding Blood Glucose levels


So you are newly diagnosed as a diabetic and you know that you have to monitor your blood sugar levels, and you know this because the Doctor told you that.

But what you don’t know is what it actually means. This should help.


Blood sugar concentration, (or in reality glucose level), refers to the amount of glucose present in your blood. Normally the blood glucose level is maintained at a reference range between about 3.6 and 5.8 mM (mmol/l). It is tightly regulated as a part of metabolic homeostasis.

WTF? Exactly what does that mean?

metabolic homeostasis basically means keeping (or regulating) the internal systems so as to keep a stable condition.

Mmol/L is the standard unit of measurement and refers to micro moles per litre and you don’t need to understand the chemistry but in case you want to know:

SCIENCE BIT:
Average normal blood glucose levels in humans are about 5mM (mmol/l) this is because the molecular weight of glucose, C6H12O6, is about 180 g/mol). The total amount of glucose normally in circulating human blood is about 3.3 to 7g – because an average human contains about 5 litres of blood. (That is just over a gallon in old money). Glucose levels vary a little during the day, rising after meals for an hour or two by a few grams and are usually lowest in the morning, before the first meal of the day (unless you are a secret midnight snacker).


So, what is this GLUCOSE stuff? Well it is carried by the bloodstream from the intestines or liver to body cells, it is the primary source of energy for body's cells, fats and oils (ie, lipids) being primarily a compact energy store, kind of like a battery. It really doesn’t mean that you should stop eating sugar, it means that you need to better control the type of food that you eat. But that is a separate story.

Failure to maintain blood glucose in the normal range leads to conditions of persistently high (hyperglycemia) or low (hypoglycemia) blood sugar. And that means that your body is not maintaining metabolic homeostasis.

A diabetic fails to maintain metabolic homeostasis and normally is hyperglycaemic and has very high glucose levels and this is often characterised by a constant thirst, with the resultant frequent trips to the loo.

Earlier on in treatment, a diabetic may also start to suffer hypoglycaemic attacks. This is often because the medication has not returned the body to stability and may well be over compensating.

So, at first, you really need to monitor your blood glucose levels, and map it against the food that you eat. That way you can see the effects of what you eat and the medication that you take.

As Alexandr would say ‘Simples’

Blood Sugar Testing - If, like me, you are Type 2 Diabetic, you will probably have had your testing strips stopped by your local Medical practice - it may well be a simple cost cutting exercise, but in the long term it is an action that may well cost the NHS even more.

Accord undertook a study into type 2 diabetics in USA and Canada and found that intensively targeting blood sugar to near-normal levels in adults with type 2 diabetes ... does not significantly reduce the risk of major cardiovascular events, ... , but increases risk of death, compared to standard treatment.

The study set two strategies for diabetic control, one aggressively targeting A1C to less than 6 percent – similar to that found in adults without diabetes, and one aimed at lowering blood sugar levels to an A1C of 7 to 7.9 percent – a target similar to what is achieved, on average, by individuals treated for type 2 diabetes in the United States.

Other earlier medical trials have shown that lowering A1C to around 6 or better reduces the risk of retinopathy or neuropathy and thus reduces the risk of blindness or amputation. However, and this is a BIG however, the ACCORD trial suggests, (at least to me) that this is at the expense of increased risk of death, compared with and A1C of around 7. In the detail of the study, I believe that the increased risk is linked to Hypo's.

I believe that this means that improved understanding of blood glucose levels is absolutely essential for diabetics, and as such testing needs to come high up the agenda list, not removed completely. SO come on NHS, get us diabetics testing again!! Then we can know for sure if we are dipping towards Hypo's - sometimes I don't get the symptoms even though my glucose levels are very low. I think that means that I am one of those people that will go into hypo shock without realising it is coming. Now I am beginning to think to myself that I am probably going to worry myself into a heart attack and thus 'prove' the study results.



ACCORD - Action to Control Cardiovascular Risk in Diabetes is a study into why patients with type 2 diabetes mellitus die of cardiovascular disease (CVD) at rates two to four times higher than non-diabetic populations of similar demographic characteristics.

ACCORD

Sponsor: National Heart, Lung, and Blood Institute of the National Institutes of Health Studied: 10,251 patients in the USA, Canada

The following is taken from a press release on June 6th 2008.
ACCORD Clinical Trial Publishes Results --

A Therapeutic Strategy Targeting Blood Sugar to Near-Normal Levels Does Not Reduce Cardiovascular Events But Increases Mortality in Persons with Diabetes at High Risk

Intensively targeting blood sugar to near-normal levels in adults with type 2 diabetes at especially high risk for heart attack and stroke does not significantly reduce the risk of major cardiovascular events, such as fatal or nonfatal heart attacks or stroke, but increases risk of death, compared to standard treatment. Researchers from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) clinical trial compared a medical strategy aimed at near-normal blood sugar levels – below current recommendations -- to a strategy to reach more standard blood sugar levels. Supported by the National Institutes of Health, the study evaluated the effects of intensively targeting blood sugar control among adults with established diabetes, high blood sugar levels, and pre-existing heart disease or at least two cardiovascular disease risk factors in addition to diabetes.

The first published results of the ACCORD trial of over 10,000 participants appear online in the New England Journal of Medicine (NEJM) today and will be in the June 12 NEJM print edition. The results are being presented at the American Diabetes Association's 68th Annual Scientific Sessions in San Francisco on June 10.

In February, the NIH's National Heart, Lung, and Blood Institute (NHLBI) stopped the intensive blood sugar strategy after an average of 3.5 years of treatment, instead of the planned 5.6 years, due to safety concerns. The intensive strategy group had a 22 percent higher risk of death – or 54 more deaths -- compared to the standard group. The increased risk began emerging within 1 to 2 years after the strategy began to aggressively lower the participants’ blood sugar levels. All participants now follow a medical strategy to reach the standard blood sugar levels while other components of the study continue.

"ACCORD is providing important evidence to help guide treatment recommendations for adults with established type 2 diabetes who have had a heart attack or stroke or who have two or more risk factors for cardiovascular disease in addition to diabetes," said NHLBI Director Elizabeth G. Nabel, M.D. "For these individuals, intensively lowering blood sugar to near-normal levels appears to be too risky."

The researchers caution that the results might not apply to patients who are at lower risk of cardiovascular disease than the ACCORD participants or to patients with more recently diagnosed type 2 diabetes. On average, ACCORD participants had been diagnosed with diabetes for 10 years at enrollment.

ACCORD's ongoing studies of the effects of aggressively lowering blood pressure and treating multiple blood lipids (cholesterol and triglycerides) in high-risk diabetic patients are expected to continue through June 2009.

"Adults with type 2 diabetes are two to four times more likely than adults without diabetes to die from heart disease, so identifying the safest and most effective ways to help them lower their risk of heart disease, stroke, and death is critical," Nabel noted. An estimated 21 million Americans have diabetes and 284,000 die from it each year. Sixty-five percent of deaths in persons with diabetes are from cardiovascular causes.

Conducted at 77 sites nationwide and in Canada, ACCORD randomly assigned 10,251 participants between the ages 40 and 79 (average age 62) to standard or intensive blood sugar treatment goals. Therapy in both groups included patient education and counseling, and treatment with any of the major classes of Food and Drug Administration-approved diabetes medications, as prescribed by their study clinician: metformin, thiazolidinediones (TZDs, primarily rosiglitazone), insulins, sulfonylureas, exanatide, and acarbose. Combinations of medications could be used as needed to reach the treatment goals.

Hemoglobin A1C levels, a standard measure of average blood sugar levels over the preceding two to three months, were used to monitor participants' blood sugar. The standard strategy group (5,123 participants) aimed to lower blood sugar levels to an A1C of 7 to 7.9 percent – a target similar to what is achieved, on average, by individuals treated for type 2 diabetes in the United States. The intensive strategy group (5,128 participants) had an A1C blood sugar target of less than 6 percent – similar to that found in adults without diabetes. To join the study, participants needed to have an A1C level of 7.5 percent or higher; at study enrollment, one-half of the participants had an A1C level over 8.1 percent.

Half of the participants in the standard strategy group achieved an A1C less than 7.5 percent, and half of the intensive strategy group achieved an A1C less than 6.4 percent. On average, participants in both groups achieved these levels within the first year of the study and maintained them throughout the study.

After an average of 3.5 years, 257 people in the intensive strategy group died, compared to 203 participants in the standard strategy group. This difference of 54 deaths resulted in a 22 percent increased death rate in the intensive group. Causes of death were similar in each group, with about half from cardiovascular conditions, such as heart attack, sudden cardiac death, stroke, or heart failure. However, the intensive group had 41 more cardiovascular deaths than the standard group, resulting in a 35 percent higher cardiovascular death rate.

"Despite detailed analyses, we have been unable to identify the precise cause of the increased risk of death in the intensive blood sugar strategy group," noted lead author Hertzel C. Gerstein, M.D., M.Sc. "Our analyses to date suggest that no specific medication or combination of medications is responsible. We believe that some unidentified combination of factors tied to the overall medical strategy is likely at play." Gerstein holds the Population Health Research Institute Chair in Diabetes and is director of the Division of Endocrinology & Metabolism and Diabetes Care and Research Program at McMaster University and Hamilton Health Sciences, Hamilton, Canada.

To meet their more aggressive targets, participants in the intensive group used more medications, were more likely to use combinations of medications, and changed medications and/or doses of medications more frequently than those in the standard group. For example, 52 percent of participants in the intensive strategy group were on three oral medications plus insulin compared with 16 percent of participants in the standard strategy group. The intensive strategy was associated with more adverse side effects from medications, hypoglycemia (low blood sugar) events, weight gain, and fluid retention.

The researchers also studied whether participants' characteristics at enrollment had an impact on their outcomes. They compared persons with and without existing cardiovascular disease, women and men, those older and younger than age 65, those with A1C levels lower and higher than 8 percent, and white and non-white participants. Death rates were consistently higher in the intensive strategy group regardless of baseline characteristics. However, compared to participants in the standard group, those in the intensive group who began the study with no history of heart attack or stroke, or with lower blood sugar levels (A1C level 8 percent or less) had fewer combined cardiovascular events – fatal and nonfatal heart attacks or strokes – during the study.

The increased risk of death from the intensive strategy surprised researchers and other experts because earlier studies had shown that blood sugar at near-normal levels was associated with lower cardiovascular disease risk in people with type 2 diabetes. However, these were observational studies, rather than randomized clinical trials, as they did not test treatments to reduce blood sugar. In addition, intensive blood sugar control has been shown in clinical trials to reduce microvascular complications from diabetes – including eye, kidney, and nervous system diseases – in people with type 1 or type 2 diabetes, and to lower cardiovascular disease risk in people with type 1 diabetes. However, the levels tested in other studies were not at as low as the level targeted in the ACCORD intensive treatment group.

The American Diabetes Association's clinical guidelines recommend that most people with type 2 diabetes reach and maintain an A1C of less than 7 percent. The guidelines also state that treatment should be individualized. For example, a less stringent A1C goal should be considered for people with severe or frequent low blood sugar or with other medical conditions.