Diabetes guidelines need revision.

• Position: Glucose Levels

Doctors with diabetic patients should aim for much lower levels of blood glucose than current guidelines suggest, advises a physician with the Pennington Biomedical Research Center, Baton Rouge, La. He believes the current recommendations for blood sugar levels are not low enough to avoid heart disease, a major complication of diabetes.

William Cefalu maintains that, if the medical community believes long-term control of blood sugar levels can reduce the risk of cardiovascular disease, then "a reassessment of our clinical goals may be in order." His work shows that more aggressive control of blood sugar levels, by use of a more intensive insulin regimen, appears to help avoid long-term cardiovascular disease.

Currently, physicians counsel their patients with Type I (also called juvenile diabetes) and Type II (often called adult-onset diabetes) to maintain adequate long-term blood sugar glucose control by achieving an A1C test of seven percent, which is suggested by the American Diabetes Association. The A1C is a simple test widely used by physicians during normal office visits to determine blood sugar levels. It measures the amount of blood sugar attached to hemoglobin, a protein found in red blood cells. A normal level is considered to be...