New diabetes study supports intensive treatment

[Beth1708]

A week after the medical community was stunned by research showing that aggressive treatment of diabetes produced a higher death rate, a new analysis by a separate team of researchers has found that intensive treatment does not pose such a risk.

The take-home message from the back-to-back studies - the first led by a team of American researchers, the latest by Australians - is not one of scientific flip-flopping but one of taking a wait-and-see approach, doctors said yesterday. Neither study is the be-all and end-all of diabetes research.

"I think our current goal for achieving [blood sugar] control in patients with type 2 diabetes is based on information accumulated over decades," said Dr. Kenneth Hupart, chief of endocrinology, diabetes and metabolic disorders at Nassau University Medical Center. "To look at these studies as reasons to alter current care would not be advised."

Hupart underscored that patients should follow the advice of their physicians because the treatment of diabetes is often highly individualized.

"It would be the wrong message for patients to abandon their treatment based on [the U.S.] trial. It has been shown that striving for better control can prevent or delay kidney disease, eye disease and nerve disease. These are true scourges for patients with diabetes," Hupart said of the disorder's complications.

Scientists at the George Institute for International Health in Sydney say aggressively reducing blood sugar is not dangerous. Interim results from their study, called ADVANCE, does not suggest a higher death rate because blood sugar is intensively lowered.

Last week's bombshell findings stirred doctors and patients alike. Known as the ACCORD clinical trial, the analysis of American and Canadian patients with type 2 diabetes revealed that with aggressive lowering of blood sugar came an increased risk of death.

The study of more than 10,000 patients was aimed at reducing blood sugar to a level comparable to that of people without the disease. Patients also had heart disease or were at elevated risk for it. So alarmed were scientists by the increased incidence of death, they abruptly halted the aggressive-treatment arm of the study. Another arm that is ongoing did not require such care.

Doctors found in their preliminary analysis about 254 deaths in the group undergoing intensive treatment compared with 203 among those less stringently treated.

"The study has to be scrutinized by people who have an understanding of the field, and it needs to be evaluated properly before broad-brush statements are painted that scare patients," said Dr. Stanley Mirsky, an endocrinologist at Lenox Hill Hospital in Manhattan.

Still, doctors could not explain why the two studies produced such starkly different results. "As we have said for two decades now, aggressive, intensive therapy is not for everyone," said Dr. Richard Kahn, chief scientific and medical officer of the American Diabetes Association. "Patient care needs to be individualized."

Kahn added that the results from a Veterans Administration study are expected in the coming months and should help doctors better understand the two current analyses.

http://www.newsday.com/news/health/ny-hsdiab155577709feb15,0,6387929.story

[tom sawyer]

Anyone know what sort of "aggressive treatment" they were using? A drug regimen no doubt. Possibly accompanied by the ADA-approved high carb diet.

[MizKitty]

Yes, the aggressive treatment was heavy dosages of not only oral diabetic meds, but heavy dosages of blood pressure lowering drugs and statins. I wish they wouldn't leave that info out.

[doreen T]

I think the "intensive and aggressive" treatment to lower blood sugars as quickly as possible involved insulin injection, as well as oral anti-diabetes drugs. In fact, I'm sure I read that in a media release .. will dig around to find it


Doreen

[doreen T]

Yes, an editorial article published at Medscape discusses the ACCORD findings. http://www.medscape.com/viewarticle/569886

Registration (free) is required to read the whole thing, but I'll quote the relevant bit here .. In an interview with heartwire, Dr John Buse (University of North Carolina, Chapel Hill), ACCORD steering committee member and president of medicine and science at the American Diabetes Association, suggested three basic possibilities that would explain the higher mortality rate in the intensively treated group .....

(snipped)

Too Many Interventions?

Buse's personal belief is that the increased mortality may not have been due to the level of A1C but more to do with the intensity of the intervention. "The patients enrolled in this study were quite vulnerable in that they were relatively old (average age 62) and had heart disease or at least two or more other risk factors for heart disease. Maybe we just flogged them too hard to get their sugar levels down. The intensive group had extremely rigorous treatment, with some patients taking four shots of insulin and three pills and checking their blood-sugar levels four times a day. Perhaps this was just too many drugs at too high a dosage, and the effort required just stressed them out too much. I think our conclusion is therefore that we should not be zealots about lowering blood sugar at all costs. We must understand that there are risks and benefits and one size probably does not fit all patients," he said.

But he pointed out that both groups in ACCORD did very well compared with similar patients in real life, who have a mortality rate two to three times that seen in either group in this study. .....

There's no mention of diet in this article.


Doreen

edited to add ... This article was also discussed by Dr. Mike Eades on his blog, and posted here .. http://forum.lowcarber.org/showthread.php?t=364133