 People with type 2 diabetes are at elevated risk for a number of serious health problems, including heart disease, premature death, blindness, kidney failure, amputations, fractures, frailty, depression, and cognitive decline. And the higher people's blood sugars are, the more heart attacks and strokes they have, the shorter their life spans, and the higher their risk of complications, like blindness and kidney failure. So a study was designed in which 10,000 diabetics are randomized into an intensive blood sugar-lowering intervention, where they put people on one, two, three, four, five different classes of drugs with or without insulin to drive blood sugars down into the normal range. Of course, you're not treating the underlying cause, you're not actually treating the actual disease, but by lowering one of the effects of the disease, these high blood sugars, by any means necessary, the hope was to prevent some of the devastating complications. How'd they do? The intensive blood sugar-lowering with drugs increased mortality. After reviewing mortality trends, they conclude that the harm associated with the increased risk of death outweighed any potential benefits, and they stopped the study prematurely for safety reasons. They were successful in bringing people's blood sugars down, but in trying to push people's hemoglobin A1c under six, they ended up pushing people six feet under, perhaps due to the adverse effects of the very drugs used to treat the disease. Even just injected insulin itself may promote cancer, obesity, atherosclerosis, worse than diabetic retinopathy and accelerate aging. Insulin therapy may promote inflammation in the lining of our arteries, which may explain the results of this trial, and other trials like it that show the same thing— no reduction in these so-called macrovascular complications, heart attacks, and strokes with intensive blood sugar-lowering. However, intensive therapy was associated with a 21% reduction in the development of microvascular complications, like kidney dysfunction. But any such benefit should be weighed against the increased risk of dying, increased weight gain, increased risk of severe hypoglycemia, and the intensively treated patients. So, trying to normalize people's blood sugars with drugs might not be such a good idea. It should be noted, though, that these trials relied virtually exclusively on drugs and did not include any serious effort at diet and lifestyle change. A 2013 paper in the New England Journal of Medicine found that an intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events like heart attacks and overweight or obese adults with type 2 diabetes. It did not increase their risk of death, but it did not seem to decrease it. In fact, the trial was stopped after about 10 years on the basis of futility. I mean, they lost weight, but they weren't dying any less, and that's what we see across the board in these types of lifestyle interventions. It's good that the dietary intervention wasn't killing anyone, but why wasn't it actually helping people live longer? Because they didn't actually put them on a healthier diet. They just put them on a smaller diet, a calorie restricted diet, meaning a sense of the same lousy diet, but just in smaller portions. If we eat less and exercise more, we can lose weight, get more physically fit, slim and have better blood sugar control, but if our diets continue to be so unheart healthy that our bad LDL cholesterol doesn't improve, then we're not going to be unclogging our arteries, whereas individuals following healthier diets may experience improved reductions in blood sugar, body weight and cardiovascular risk. Yes, by eating a smaller quantity of food without changing quality, we can lose weight, but the point of a lifestyle intervention is not to just fit people into skinnier caskets.