Re: Another ADA myth exposed - Tight Control

Chris Malcolm <cam@xxxxxxxxxxxxxxxxx> wrote:
Ozlover <this@xxxxxxxxxxxxxxxxx> wrote:
Chris Malcolm <cam@xxxxxxxxxxxxxxxxx> wrote:
Ozlover <this@xxxxxxxxxxxxxxxxx> wrote:
Paul L <paul@xxxxxxxxxxx> wrote:
On 4/21/2010 1:38 PM, Ozlover wrote:
Chris Malcolm<cam@xxxxxxxxxxxxxxxxx> wrote:
Ozlover<this@xxxxxxxxxxxxxxxxx> wrote:
Chris Malcolm<cam@xxxxxxxxxxxxxxxxx> wrote:
Ozlover<this@xxxxxxxxxxxxxxxxx> wrote:
Chris Malcolm<cam@xxxxxxxxxxxxxxxxx> wrote:
Kurt<kurtwheeling1965@xxxxxxxxxxx> wrote:
On Apr 17, 2:15???pm, Trinkwasser<s...@xxxxxxxxxxxxxxxxxxx> wrote:

And yet they manage to comfortably exceed the ADA's expectations.

How can you exceed achieving as near non-diabetic numbers as safely
possible?

That's not their expectations. That's treatment advice. As they point
out, their expectations are largely derived from a large
epidemiological study of T1s, plus a few small studies of T2s in which
tight control was achieved by raising medication levels.

"achieved by raising medication levels"! Nice piece of spin! My
congratulations!

You didn't follow the discussions we had here of those research papers
about T2 tight control? It's not spin, it's what they quite
specifically say they did!

Of course I did follow the discussions, and they (the research papers)
did *not* say *that*, hence my comment that it's spin. Not *really*
rocket science.

Do you really have such a poor memory? Are you incapable of checking
back on something so easily checked? Haven't you realised yet that I
have a good memory? Haven't you realised yet that I check things?

Obviously not! :-)

Here you go again. Trying to find fault in *others* for *your*
comments.

In answer to your 'questions': My memory is good to excellent. I don't
need to check, because I know/remember. It doesn't matter that you have
good memory, because your 'interpretation' is a misrepresentation. That
you remember earlier misrepresentations doesn't help, unless you realize
and admit that they are misrepresentations.

Here's the paper we discussed in January this year. You took part in
the discussion thread. As they very clearly explain, of the nearly
50,000 type 2 diabetics in this study, every single one was taking
diabetic medication. They split the population into two groups: those
taking less medication, and those taking more.

Which is yet another spin of what they actually write.

And no, I'm not going to 'discuss' why the spin is spin, because past
experience has shown that you will deny that it's spin. Apparently that's
what spinners do.

Curious that you do not acknowledge the *obvious* fact that all
particpants were taking medication ... cut and pasted to isolate
this fact:

I obviously - implicitly - acknowledge that the study says what it
does.

What I object to is Chris' *misrepresentation* of what the study says,
and more specifically what it does *not* say.

It's rather simple: Read the study and read Chris' comments. They
don't say the same thing.

Let me turn your questions around:

Does the study say "[tight control was] achieved by raising medication
levels" (or words to that effect)?

Does the study say "They split the population into two groups: those
taking less medication, and those taking more." (or words to that
effect)?

Answers: No, the study doesn't say anything like *that*!

What is being discussed here isn't the study, it's the abstract!

OK. But it doesn't change a thing. Read on.

The abstract is only meant to give enough of an idea of what kind of
stuff is in the report for you to take a reasonable decision about
whether it would be interesting to read the report. And scientists are
often not the most literarily skilled of summarisers. So rather than
nit picking over phrases in the abstract it would be better to consult
the full report.

Not surprisingly what they did was rather more complicated than what
the abstract suggests. Here are some relevant extracts. Everything is
a verbatin quotation except for my comments which are in paragraphs
prefaced by "--".

------------------------------------------------

Results of intervention studies in patients with type 2 diabetes have
led to concerns about the safety of aiming for normal blood glucose
concentrations. We assessed survival as a function of HbA1c in people
with type 2 diabetes.Results of intervention studies in patients with
type 2 diabetes have led to concerns about the safety of aiming for
normal blood glucose concentrations. We assessed survival as a
function of HbA1c in people with type 2 diabetes.

[...]

In this retrospective cohort study, our aim was to assess the
association between all-cause mortality and HbA1c in patients with
type 2 diabetes in a primary-care setting, and establish whether any
evident association was independent of the diabetes treatment regimen.

[...]

We obtained data from routine general practice in the UK from a
proprietary health data resource: the General Practice Research
Database (GPRD).[10] and [11] GPRD was established in 1987, and
contains data derived from computerised records.

[...]

Data were obtained from November, 1986, to November, 2008, inclusively.

[...]

We identified all patients who had a diagnosis of type 2 diabetes and
whose treatment history included evidence of a specific escalation of
their diabetes treatment. We included in the analysis those who had
received oral blood-glucose lowering drugs or a prescription of
insulin, and were older than 50 years. Patients also needed to have a
case history of more than 6 months before they were eligible for
classification into one of two treatment groups for analysis. We
excluded those who had a record of diabetes secondary to other causes
(eg, gestational or drug-induced diabetes) and those who did not have
at least 12 months of exposure after their respective index date.ie,
the date at which they were started with either specific regimen.

-- The two regimens were those who were only on oral medication, and
those who were using insulin. Both groups had to have a history of
having had their medication increased in order to maintain BG control.
In other words the only diabetics studied were T2s on medication
whose medication had been increased in order to maintain control.

How the hell do you arrive at "had their medication increased"?

You just quoted it in the above -- "... whose treatment history
included evidence of a specific escalation of their diabetes
treatment." In a study where the only treatment is medication that
means increasing the medication.

Nope.

*That* is your spin, i.e. what you initially wrote as ""achieved by
raising medication levels"".

In the words of the study tighter BG control was achieved by
"escalating treatment". They'd all been taking medication. After some
time their doctors thought their BG control was failing, A1Cs getting
too high. In order to lower their A1Cs their doctors then "escalated
treatment" by giving them more or stronger medication. I rephrased
that as "raising medication levels".

Nice fairy tale. The study doesn't say *any* of this (except
"escalating treatment"). Your overinterpretation is yours and yours
only.

I can't see any spin. I can't understand what you're arguing about.

Read the part which you snipped. And read what the *researchers*
said that "escalating treatment" means (in this context).

And leave it at that! I already said that I had no intention of
discussing your spin, because you would deny that it is spin. Somehow I
got sucked in again, and what I said would happen, did indeed happen.

--
Frank Slootweg
.

Relevant Pages

  • Re: Another ADA myth exposed - Tight Control
    ... tight control was achieved by raising medication levels. ... Results of intervention studies in patients with type 2 diabetes have ... evident association was independent of the diabetes treatment regimen. ...
    (alt.support.diabetes)
  • Re: Another ADA myth exposed - Tight Control
    ... tight control was achieved by raising medication levels. ... Results of intervention studies in patients with type 2 diabetes have ... evident association was independent of the diabetes treatment regimen. ... treatment regimens. ...
    (alt.support.diabetes)
  • Re: Another ADA myth exposed - Tight Control
    ... tight control was achieved by raising medication levels. ... Which is yet another spin of what they actually write. ... "Results of intervention studies in patients with type 2 diabetes have ... compared with the glycated haemoglobin (HbA1c) ...
    (alt.support.diabetes)
  • Re: Another ADA myth exposed - Tight Control
    ... tight control was achieved by raising medication levels. ... Results of intervention studies in patients with type 2 diabetes have ... We assessed survival as a function of HbA1c in people ... evident association was independent of the diabetes treatment regimen. ...
    (alt.support.diabetes)
  • Re: My Diabetes is Bigger Than Your Diabetes (was Re: kidney problems)
    ... reading high enough to provoke the clinical diagnosis of diabetes even ... And still her endo hasn't started her on any medication ... I sincerely hope my diabetes isn't the biggest. ... Comments similar to yours concerning Emily's treatment; ...
    (alt.support.diabetes)