Putting the clamps on blood glucose did not prevent eye, nerve or kidney complications in a large cohort of patients with type 2 diabetes, according to a study in the New England Journal of Medicine. 

William Duckworth and colleagues at the Phoenix VA randomized 1,791 veterans with an average  baseline glycated hemoglobin of 9.4% to intensive or standard therapy and followed them for 6 years.

Patients had diabetes for an average of 11.5 years prior to randomization. Nearly 40% had sustained a cardiovascular event and 60% had developed microvascular complications prior to randomization.

The same oral drugs were used in both groups but they were used more aggressively in the intensive therapy group. Insulin was added when glycated hemoglobin exceeded 6% and 9% for the intensive and standard groups, respectively.

Median glycated hemoglobin levels during the study were 8.4% and 6.9% for those in the standard and intensive therapy groups, so there’s no question diabetes control was tighter in the latter group.

However, the need for photocoagulation during the study was 15.7% and 15.5% for those in standard and intensive therapy, respectively.

Similarly 4.0% and 5.7% of those in standard and intensive therapy groups experienced progression to proliferative eye disease (not a misprint). A doubling of serum creatinine was seen in 8.8% of patients in both groups.

Neuropathy developed in 43.8% and 43.5% of those in standard and intensive therapy respectively, so across the board there were no real differences.

Cardiovascular outcomes and all-cause mortality also did not differ, but hypoglycemic episodes were 4 times more frequent in those receiving intensive treatment. 

The cardiovascular results confirmed findings from other studies but left open the possibility that a longer follow-up period might reveal benefits for those receiving intensive treatment. 

Helena Rodbard, M.D., a former president of the American Association of Clinical Endocrinologists, concluded for MedpageToday that “the upshot of it is, if we catch the patients early on, they are going to benefit from intensive treatment.” 

But “if we wait too long, intensive treatment can be deleterious,” she warned.

In that thoroughly modern moment of desperation when your computer has frozen tighter than the credit market and it needs to be fixed like right now so you’ve dialed tech support, few things are as absurdly frustrating as an unintelligible foreign voice on the other end of the line.

But that happens quite frequently because companies can save 50-70% on call center costs by outsourcing the function to places like Bangalore and Manila.

Now Dell is offering an alternative. For $99 per year, new computer buyers can purchase a service package which comes with technical support based in North America, guaranteed.

And your call will be answered in 2 minutes or less.

Sans upgrade though, you’re likely to get someone from the Philippines, India or some other place that has a contract to provide technical support for Dell.

“We’ve heard from customers that it’s hard to understand a particular accent and that they couldn’t understand the instructions they were getting,” Dell spokesman Bob Kaufman told the Washington Post. “This (new plan) illustrates Dell’s commitment to customer choice.”

Lyn Kramer, who operates a call-center consulting business isn’t buying that, however. “Most people in the customer service world believe that if you have sold me a product, then support for that product should be free,” she told the Post.

Meanwhile Sharmila Rudrappa, a native of Bangalore and professor of sociology at UT Austin added the issue had nothing to do with racism.

“When things go haywire, you want assurance, you want familiarity, you want someone to hold your hand and say it’s OK…you don’t want…to have to work at understanding the person at the other end of the line.”

And since when did the accents of Nashville, Boston, and Nova Scotia become so easy to understand?

A thousand people live in McCullom Lake Village and 14 of them have developed brain cancer. That’s between 2 and 20 times more than would be expected based on the reported incidence of brain cancer in the general population.

Just a case of bad luck?

“Absolutely not,” according to Aaron Freiwald an attorney who represents local residents in lawsuits against the multinational chemical company Rohm and Haas.

The billion dollar company has operated a production facility in McCollum Lake Village since 1963. The plant produces everything from pesticides to plastics, and byproducts of these processes cause cancer.

Rohm and Haas admits it dumped toxic byproducts into an 8 acre pit on its property for 20 years before ceasing the practice in 1979. There was nothing illegal about that practice at the time.

This May, the county tested 14 of the town’s water wells for contamination. They all came up clean.

To which the residents counter that no testing was done back when Rohm and Haas was dumping the chemicals. “They knew that there were chemicals in there – that they were dangerous,” Freiwald told CBS. 

And besides, there are more than 14 wells in town.

Meanwhile, it’s possible there’s a second brain cancer cluster at a Rohm and Haas plant in Philadelphia, where 12 research scientists died of the disease in the past 30 years. Five of them worked along the same hallway. 

“That could be a coincidence,” Dr. Phil Lewis told CBS.

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