Lack of benefits from blood glucose-lowering diabetes treatment, doctors confused

.
This is the key conclusion from the recently published study.

Glycemic Control for Patients With Type 2 Diabetes Mellitus
Our Evolving Faith in the Face of Evidence

Abstract

...We searched in top general medicine and specialty journals for articles referring to glycemic control appearing between 2006 and 2015 and identified the latest practice guidelines.
...
We identified 16 guidelines and 328 statements. The body of evidence produced estimates warranting moderate confidence. This evidence reported no significant impact of tight glycemic control on the risk of dialysis/transplantation/renal death, blindness, or neuropathy. In the past decade, however, most published statements (77%–100%) and guidelines (95%) unequivocally endorsed benefit. There is also no significant effect on all-cause mortality, cardiovascular mortality, or stroke; however, there is a consistent 15% relative-risk reduction of nonfatal myocardial infarction. Between 2006 and 2008, most statements (47%–83%) endorsed the benefit; after 2008 (ACCORD), only a minority (21%–36%) did.

Conclusions — Discordance exists between the research evidence and academic and clinical policy statements about the value of tight glycemic control to reduce micro- and macrovascular complications.

And journalistic commentary, from the CBC:

New study questions Type 2 diabetes treatment
No evidence glucose-lowering drugs help ward off long-term complications, researchers say

It's a curious case of missing evidence. When a diabetes specialist searched the medical literature looking for proof to support the use of glucose-lowering drugs for Type 2 diabetes, he couldn't find it.

...
His conclusions challenge the conventional wisdom of many medical specialists, and contradict most clinical practice guidelines.

...
"Over 90 per cent of experts were saying that controlling blood sugars tightly was associated with a reduction in your risk of going blind or of needing dialysis or having to undergo an amputation," Montori said. "But when we looked at the evidence for that, we could not see any signal that would suggest that is true despite the question being asked at least since the 1970s."
...
The finding reveals a divergence in professional opinion based on the same set of facts, and it exposes a dilemma in the science of Type 2 diabetes — that doctors don't completely understand the relationship between blood sugar and the disease.

My comments:

1) The lack of benefits from glucose lowering therapies may be explained by the primary cause of the damage being the total carbohydrate overload (Glycemic Load) rather than the blood glucose level.

2) The results are consistent with the research published by R.W.Stout (Lancet, 1969) demonstrating arteriosclerotic plaque production stimulated by glucose and insulin. Reduction of carbohydrate consumption therefore reduces both glycemic load and insulin secretion, reducing the overall risk, especially cardiovascular. Some glucose level controlling drugs only push glucose from one location (blood) into another (tissues) without generally affecting insulin secretion and therefore unchanging the risk, while some other drugs that do increase insulin would also increase the risk.

3) Confusion among medical professionals stems from their attachment to the Western food and lifestyle, unable to consider a possibility that the high carbohydrate nutrition may by itself be the main trigger (if not the cause) of diabetes. In my personal opinion, best remedy would be to allow more free play and competition in the medical field, enabling doctors trained in other countries that may not be subject to the above described mind blocks, to practice legally world-wide, as it is already being widely accepted in other professions such as engineering, scientific research and art.

Stan (Heretic)