Tight control—keeping the HbA1c under 7 percent—is clearly worthwhile for people with type 1 diabetes. But the benefits aren't as certain for some type 2 patients. While research does show that keeping their blood sugar levels near normal reduces diabetes-related complications in the eyes, kidneys, and nerves, strict control may not lower their risk of cardiovascular disease. In fact, a study published in the June 12, 2008, issue of The New England Journal of Medicine linked intensive therapy with increased mortality. Whether the excess deaths were due to dangerously low blood sugar levels, some interaction among the drugs used in the study, or other factors remains uncertain.

Our take

People with type 2 disease who have limited life expectancy or are struggling with multiple health problems needn't obsess about strict control, because the risks of intensive therapy for them might outweigh its benefits. But it is worthwhile for most other people.

Will I have to monitor my blood glucose at home?

While patients and their physicians often assume that diabetes management requires daily home testing, recent studies suggest that it doesn't benefit many patients, adds to the cost of diabetes treatment, and can lead to anxiety and depression. But there are a few situations, listed below, when frequent monitoring makes sense.

Our take

Patients who use insulin need monitoring so they can adjust insulin doses if necessary and guard against dangerous drops in blood sugar levels. And those who are newly diagnosed may want to monitor blood sugar patterns more closely at first to understand how they fluctuate with meals, exercise, stress, and medications. See some home monitors that performed well in our recent tests.