In other areas of diabetes care, the American Academy of Endocrinologists (AACE) has spent the past year promoting new and stricter guidelines for maintaining near normal blood sugar levels in diabetics with life threatening conditions in the intensive care unit. At the same time several studies have failed to show any meaningful benefit of this approach while another showed an increase in overdosing with insulin and potential increase in complications for those receiving the AACE promoted approach. Making matters worse is that the AACE protocol adds substantially to cost and nursing requirements. I personally hope the AACE officially abandons what appears to be a costly and dangerously aggressive approach to the management of diabetes.

The Accord Study is aimed at diabetes management outside of the hospital and encountered problems, which mirror those, found in the intensive care unit. In the last few months a portion of the Accord Study had to be stopped earlier than planned due to increased complications occurring in patients receiving more aggressive blood sugar control (aimed at keeping the blood sugar lower) than the present standard.

Finally, in what could rank as one of the longest stumbles in medical history, last month the American Diabetes Association gave its support to a low carbohydrate diet as a method for weight loss in diabetics. This occurred a mere 26 years after Dr. Robert Atkins published his world famous low carbohydrate weight loss method.

Gary Pepper M.D.

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