- The wrong paradigm may be driving drug glucose control in the face of the evidence
Boussageon et al are the latest to highlight the apparent contradiction in our current thinking.
On the one hand, the epidemiological evidence shows a strong link between chronic hyperglycaemia (HbA1c) and adverse patient important outcomes and on the other hand, the RCT evidence shows lowering HbA1c by drug treatment is ineffective or harmful to patient outcomes.
This contradiction is because we are using the wrong paradigm.The current paradigm is that HbA1c has a causal relationship with adverse outcomes and that lowering HbA1c by any means, must improve patient important outcomes.
The alternative paradigm is that chronic hyperglycaemia, is partly causal but is only a late and easily measurable part of a more fundamental problem.
Our culturally “normal” diet, based on carbohydrate is biologically different from the diet the human species evolved to thrive on. A large proportion of people cannot tolerate a carbohydrate based diet over years, even “healthy whole grains”. Eating starch is eating glucose, which requires a corresponding insulin response. An insulin response with every snack and meal for years can, in genetically vulnerable people, cause insulin resistance with variable expression among people and among different body tissues. The Hyperinsulinaemia and Insulin Resistance (HAIR) is the underlying problem driving disorders of glucose and lipid metabolism characterised by...Competing Interests: None declared.