What's a patient to do?!
"When it comes to controlling blood sugar for people with diabetes, low is good, but lower may not always be better. That is the message from a major government-sponsored study intended to find the best strategy for preventing people with Type 2 diabetes from having heart attacks and strokes or dying of cardiovascular disease." - Wall Street Journal, February 7, 2008
"For decades, researchers believed that if people with diabetes lowered their blood sugar to normal levels, they would no longer be at high risk of dying from heart disease. But a major federal study of more than 10,000 middle-aged and older people with Type 2 diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported Wednesday." - New York Times, February 7, 2008
These were the opening paragraphs last week of the WSJ and NYT stories on ACCORD ~ although later in the story, advice wasn't so controversial, we felt these opening paragraphs were leading, at the very least!
One question we've heard come up a lot from patients is: "They say this is a small group - patients who have had diabetes for ten years with at least two risk factors of cardiovascular disease - how do I know if I fall into that group?" Patients also say their doctors point out that the study data hasn't been released, so the fail-safe "Don't do anything without your doctor" applies, but your doctor may not have a clear opinion about ACCORD yet. Now one thing - in the WSJ story, it says that the "at risk" group to whom the "extremely tight control might be dangerous" might apply was pegged at about 10%. When we talked to the author of the story, he said that the source of this figure was Dr. John Buse, the head of the ADA. So that's good - 10% is lower than 100% and we know Dr. Buse is a quite leading figure in diabetes. For people at high risk, of course (which for now means people with type 2 with cardiovascular disease or with two risk factors - obesity, high blood pressure, high cholesterol, or smoker), we urge you to make sure you're seeing an endocrinologist and diabetes educator and to stay close to them as more information comes out about ACCORD.
We saw a very insightful letter in this morning's NYT from Dr. Harry Shamoon and Jill Crandall, very respected doctors at the Albert Einstein College of Medicine in New York, urging patients not to forget tight control. Read on ... and thank you, thank you for what seems like most sensible advice.
We hope to see ACCORD data soon, in the meantime, so that many other questions can begin to be answered.
Re “Study Undercuts Diabetes Theory” (front page, Feb. 7):
While the interim results of the Accord trial may be disappointing to patients with Type 2 diabetes, it is important to remember that there is incontrovertible evidence from the 20-year Diabetes Control and Complications Trial that controlling high blood glucose levels does indeed prevent vascular complications.
The most recent data from this trial even demonstrated a benefit of intensive treatment of blood glucose on cardiovascular disease, an effect that persisted many years after the formal study ended.
Of course, patients with Type 2 diabetes have many other risk factors for heart disease in addition to high blood glucose, including older age, overweight or obesity, high blood pressure and abnormal lipids. The interplay between all these risk factors and glucose is likely the reason that people with diabetes are at such high risk for heart attacks.
Finally, it is clear that people with Type 2 diabetes are at the same risk for developing eye, kidney and nerve problems from high blood glucose levels as patients with Type 1 and therefore will benefit from proper control of blood glucose.
Also, since the level of blood glucose control being tested in the Accord trial was significantly lower than that ordinarily achieved in medical practice, their results should not be taken as evidence that current standards should be abandoned. For all these reasons, most diabetes experts will continue to tell their patients to keep their blood glucose levels as near to normal as feasible.
Jill P. Crandall
Bronx, Feb. 7, 2008