The latest statement by the ACP (American college of Physicians) reports that HbA1c, a marker for diabetic control, be between 7-8. Anything lower might cause hypoglycemia. Furthermore overall mortality is not affected by more stringent control.

This is clearly a contradistinction to what the ADA (American Diabetic Association) believes. I concur with the ADA that a level of 8 is NOT good enough.

First of all death is not the only end point. There are reports that many of the microvascular complications of diabetes can be mitigated by tighter glycemic control. Examples include retinopathy, kidney disease and neuropathy.

A major concern by the ACP was the risk of hypoglycemia (or low blood sugar) by tight control of diabetes. What they failed to mention is that many of the newer agents used in diabetes do not significantly lower blood sugar levels. Why I don't even use these older drugs that are infamous for lowering blood sugar.

Keep in mind that this was based on diabetics on medications. In my practice, I always start with lifestyle,My aim is to convert a diabetic to a borderline, and a borderline to a non-diabetic status. Getting the A1c below 7 and preferably below 6.5 is my aim.

Read original article here: https://www.medpagetoday.com/endocrinology/diabetes/72336

Here's more promising news about lifestyle changes and prevention of heart disease; recently published in the peer reviewed journal CIRCULATION were the results of a large study from the UK. They found that regardless of an individual's genetic risk for heart disease, those with unfavorable genetics derive as much benefit from exercise as the general population. This was a large study of a half million people over a 6 year span. Interestingly enough, they studied both cardiopulmonary fitness as well as grip strength They concluded that both aerobic activity and strength training have a positive role in mitigating the effects of unfavorable genetics when it comes to heart disease. The large sample size was deemed a strength of the study, while the observational nature of the study is an obvious limitation.

Genetics seems to be a huge deal these days. Practicing integrative cardiology, I often test for certain genetic makers. But what do you do with the information? I work with the patient and help them minimize the effects of their unfavorable gene pool by exercising (pun intended) lifestyle measures.

Read original article here: https://www.medpagetoday.com/cardiology/prevention/72221

One test that I find particularly useful in the appropriate patient is the coronary calcium scan. This is a CT scan that takes only minutes.There is no contrast involved nor any intravenous lines. This scan literally detects the presence or absence of calcium within the 3 main coronary arteries. You end up with a total calcium score. The perfect score is zero. (probably the only time in your lifetime you would be content with a zero score)! The higher the score, the greater degree of calcium in the coronaries . Besides learning the calcium burden, an individual's results are compared to a large database of several thousand patients. So you actually learn where you fare with individuals matched by your age and gender.

How do I use this test? As an integrative cardiologist, I'm simply not interested in treating everyone who walks in my door with an elevated cholesterol level with statins. I prefer to stratify my patients according to their risk. A high calcium score would bend me in the direction of more aggressive risk factor. modification.This always begins with lifestyle changes. It always boils down to diet and exercise.For me, it's all about treating those patients who need it the most!

One caveat : A zero score doesn't mean you are totally off the hook! Keep in mind that this test only measures the calcium within plaque. Plaque actually starts off as an inflammatory reaction involving smooth muscle cells and cholesterol esters. This inflammatory complex subsequently takes up calcium which is what this test detects.

Read original article here: https://www.nytimes.com/2018/04/02/well/live/the-value-and-limitations-of-a-cardiac-calcium-scan.html?smid=fb-share