September 15, 2016

In light of a recent report, the Canadian Diabetes Association (CDA) would like to stress that people being treated for type 2 diabetes should not stop taking their medication.

The report, published in the journal Circulation: Cardiovascular Quality and Outcomes on August 29, 2016, has led to a number of questions about the use of medications to control blood sugar. The CDA recommends working with your health-care team to ensure that your diabetes treatment plan is right for your particular circumstances. For most people that will include medication to lower blood glucose levels.

“We have over four decades of studies on the best way to treat type 2 diabetes and many of them support the health benefits of lowering blood glucose levels. However, they do not all point to one simple conclusion about the best treatment for every individual,” says Dr. Jan Hux, chief science officer for the CDA. “For many people the risk of complications such as damage to eyes, kidneys and nerves may be reduced by treatments that tightly control blood glucose. At the same time, others may not benefit and a small percentage may be harmed. Accordingly, our Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (CPGs) call for individualized care that takes into account both the risk and benefit of treatments for each person."

"We know that better treatment is leading to better outcomes for people with diabetes. Over the past two decades we have seen a more than 50 per cent reduction in complications, such as heart attacks, stroke and amputations. We don’t know exactly which components account for these improvements, but better blood glucose control has been part of the treatment regimens that have led to those improved outcomes,” says Hux.

The report, by Dr. Victor Montori and Dr. Rene Rodriguez-Guiterrez of the Mayo Clinic, does not represent a new clinical trial studying the impact of glucose control on outcomes in type 2 diabetes. The authors of this report looked at articles published between 2006 to 2015 to try and determine the quality of evidence for tight blood glucose control in type 2 diabetes and see how guideline recommendations match that evidence.

Type 2 diabetes is a complex disease, often (though not always) occurring in older people who have multiple health issues. Because of this, the CDA’s CPGs indicate that the treatment of blood glucose in type 2 diabetes must be individualized. Tight glucose control may not be appropriate for all and our CPGs give guidance as to which people with diabetes are most likely to benefit.