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The recent editorial, _Normal blood glucose and coronary risk_ states
"the evidence that glucose control prevents coronary heart disease is
equivocal in patients with diabetes." It is indicated that this
conclusion is unexpected, and several hypotheses are listed to explain the
finding.
Given the dates studies supporting these findings were initiated, it
seems likely that "glucose control" in Type 2 diabetics was being
primarily obtained by pharmacologically elevating insulin levels. If we
assume many subjects in these experiments were at the outset in some stage
of insulin resistance, is it not possible that the resulting therapeutic
elevation of insulin levels was simply superimposed on the pre-existing
absolute hyperinsulemia, making the problem more severe?
While further elevation of insulin levels undoubtedly lowered serum
glucose, it also may have sufficiently aggravated other cardiovascular
risk factors (abnormal lipid profile, hypertension) to mask the benefits
of glucose reduction. Of course, this could be alleviated by
"aggressively treating" the resulting "hyperlipidemia and hypertension" as
is also mentioned in the Editorial.
Glucose Reduction and Cardiovascular Risk Factors
The recent editorial, _Normal blood glucose and coronary risk_ states
"the evidence that glucose control prevents coronary heart disease is
equivocal in patients with diabetes." It is indicated that this
conclusion is unexpected, and several hypotheses are listed to explain the
finding.
Given the dates studies supporting these findings were initiated, it
seems likely that "glucose control" in Type 2 diabetics was being
primarily obtained by pharmacologically elevating insulin levels. If we
assume many subjects in these experiments were at the outset in some stage
of insulin resistance, is it not possible that the resulting therapeutic
elevation of insulin levels was simply superimposed on the pre-existing
absolute hyperinsulemia, making the problem more severe?
While further elevation of insulin levels undoubtedly lowered serum
glucose, it also may have sufficiently aggravated other cardiovascular
risk factors (abnormal lipid profile, hypertension) to mask the benefits
of glucose reduction. Of course, this could be alleviated by
"aggressively treating" the resulting "hyperlipidemia and hypertension" as
is also mentioned in the Editorial.
Yours truly,
Ronald A. Cameron, D.M.D., M.D.S.
Competing interests: No competing interests