Diabetes: Accord study using 5 different medications including insulin to control their bg's

What was never widely publicized by our wonderful media was that to obtain tight control in the ACCORD study, the subjects were using as many as 5 (yes five!) different medications including insulin to control their bg's. That part didn't make good headlines like dead subjects, I guess! The strong implication even stated flat-out in some reporting in the original published reports was that it was the low HbA1c that was the mortality cause.

It's not unusual for type II diabetics to require several medications to maintain good BG control. I myself use Byetta, metformin, and small amounts of NPH and Lantus to help with FBG. For a while I also had some Prandin on a PRN basis. I do not personally use them but most diabetics are also routinely put on blood pressure meds and statins; all of which have side effects. I think there are things to be learned from the ACCORD study if people didn't take sides and try to either, totally debunk the results or take it as gospel. My PCP and I have had some good discussions about the study and he cautions me, who has been diabetic for over 30 years with a history of heart disease in the family from striving to get my A1c too much under 6.0. People are different and although it makes perfect sense for type I's and newly diagnosed type II diabetics to keep their BG as close to normal as possible to avoid any complications that was not the case with the people who died in the ACCORD study. Many of them were elderly with heart disease and other co-morbid factors. Some of them never had good BG control and may have been pushed too hard, too fast to reduce their A1c. What I do know from personal experience as well as from my doctor's advice, including my endocrinologist, is that it is bad for my heart to experience lows. I feel best when my BG is between 90-120 and would never strive to get it lower than that. I would like to see some research that studies diabetics with heart disease to help determine optimal BG control for them. I suspect what is healthy for elderly people struggling with diabetes AND other chronic disease is quite different from what is optimal for younger, newly diagnosed diabetics. I think we need to take all of that into account and not push extreme control on people for whom it is too difficult and maybe not even necessary. Long term diabetics in later life either already have complications from the disease or may be able to manage just fine with moderate A1c levels of 6.5 - 7.0 in the years they have left. For some people it becomes a quality of life issue. As long as people are informed these decisions are personal and what is optimum may differ considerably for different people.