Is It Really Important to Keep Blood Glucose Normal In Adult Onset Type II Diabetes?

How important is it to keep "tight control" of blood glucose numbers if you have Type II Diabetes (Adult Onset Diabetes Mellitus)?

The simple answer: VERY IMPORTANT.

There was confusion last spring when one study (the ACCORD trial), seemed to suggest that people were better off if they did NOT keep their blood sugars at the "normal" range. This made no sense to physicians, and indeed, after looking more closely at the data, it appears that early, tight control of blood sugars gives substantial health benefits. Experts now agree that the best approach is to INDIVIDUALIZE the treatment of patients with Type II diabetes (imagine that!). There are many health benefits from "tight", careful control of blood sugars, as long as dangerously low blood sugars are avoided, and intolerable medication side effects are avoided.

The new study results are fascinting. You can read an abstract of the article published by the New England Journal of Medicine at: http://content.nejm.org/cgi/content/abstract/359/15/1577

To summarize, this study began with 4,209 patients with newly diagnosed diabetes, and then broke them into groups, with different treatments. One group received only dietary restrictions, another group received insulin or an older type of oral medication known as sulfonylureas, and a third group (who were overweight) received an oral medication known as metformin (or Glucophage.) To make a long story short, both medicine groups were much healthier in the long term than the diet-only group, and the metformin (Glucophage) group was healthier than the sulfonylurea/insulin group.
"In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002). "

Harvard has a nice online discussion of this study, and optimal management of Type II diabetes at:
http://health.msn.com/health-topics/diabetes/articlepage.aspx?cp-documentid=100216943
Highlights from this article: "In the past, doctors usually have told newly diagnosed patients with type 2 diabetes to try diet and exercise first to bring down their blood sugar. Now that should change. They should immediately begin taking medicine. This doesn't mean that diet and exercise are not just as important as before. As blood sugar gets under control, medicine can be tapered. In some cases, it can be discontinued.
For most, metformin should be the first medicine. This is especially true if the person is obese...There are exceptions. People with impaired kidney function probably should avoid metformin. Caution is advised with heart failure and some types of severe liver disease...Whether you were diagnosed with type 2 diabetes yesterday or 20 years ago, you want your blood pressure less than 130/80. Your LDL cholesterol should be less than 100 (preferably closer to 70). Achieving these goals clearly decreases the risks of heart attack and stroke and helps protect the kidneys.
Some doctors already advise their patients to start metformin if they are at high risk for developing diabetes. This would include obese patients with high normal blood sugar who have a strong family history of type 2 diabetes. Research is under way to help answer whether starting medicine even before the onset of diabetes improves results."

As always, discuss all treatment options with your own physician.