Treating a Number

You and your doctor have found that you have a bad number (say high blood sugar—type 2 diabetes) but you feel fine. What should you do?

The question is: What is the your (and your doctor’s) goal? Should you take a medicine to treat the number and if yes, how much medicine should you take? What should your goal for the number be?

Basically there are only a few reasons to take a medicine (or have a surgery): to feel better, to do better, or to live longer.

You want to feel better: You have a cough or a fever or an ache and you aren’t worried that it is serious but you go to the doctor because you want to feel better.

You want to do better: Perhaps you are getting short of breath when you walk and so you aren’t able to get all your work done. You want the doctor to give treatment so you don’t get short of breath.

For the living longer concern, there are two different scenarios. In the first, you are having symptoms and in the second, you feel fine but have bad numbers

The First Scenario

You want to live longer: You start getting chest pain and you want to figure out if it is serious and if it is, you want the doctor to prevent a heart attack or death.

The Second Scenario

Or you want to live longer and you feel fine but you’re concerned because you have a bad number (high blood sugar, high blood pressure, or high cholesterol).

Let’s focus on the second scenario, on type II diabetes which is by definition an abnormally high blood sugar. We know that type II diabetes is clearly associated with a shortened live span and heart, kidney, and nervous system problems in some but not all people.

We’ve always assumed that if we could get the blood sugar back to normal with medical treatment, we would decrease the type II diabetic’s risk of death and all the other problems that go with diabetes. The lower we got the blood sugar by treatment, the better off the patient would be (we assumed). It turns out that it is a lot more complicated than that.

Tomorrow I’ll talk about three studies (ACCORD, ADVANCE, and VADT) that call that assumption into question.

Lower may not be always be better for the blood sugar number.

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