Can lowering blood sugar in diabetics save lives?
According to the results of a study called Action to Control Cardiovascular Risk in Diabetes, the answer is no. But the answer should really be, it depends. It depends upon the way that low blood sugar is obtained.
The ACCORD Study and its results
In an article published in the American Journal of Cardiology on June 18, 2007, the authors of the ACCORD study said that the study tested the hypothesis that aggressive glucose lowering prevented cardiovascular events such as heart attack or stroke in patients with type 2 diabetes. On June 12, 2008, they published another article in the New England Journal of Medicine stating that they had succeeded in lowering blood glucose levels to the targeted range by means of intensive therapy but that “the use of intensive therapy to target normal glycated hemoglobin levels for 3.5 years increased mortality and did not significantly reduce major cardiovascular events.” As a result, “The finding of higher mortality in the intensive-therapy group led to a discontinuation of intensive therapy after a mean of 3.5 years of follow-up.”
The announcement that the researchers were abruptly halting the intensive therapy part of the ACCORD study was made public in February of 2008. It was front page news. An article on the front page of the New York Times of Feb. 7, 2008, had the headline: “STUDY UNDERCUTS DIABETES THEORY – Sharply Lowering Blood Sugar Increased Risk.” The article went on to say that medical experts were stunned. It quoted Dr. James Dove, president of the American College of Cardiology, ” ‘For 50 years, we’ve talked about getting blood sugar very low. Everything in the literature would suggest this is the right thing to do.’ “
The article described what was required to get blood sugar levels into the normal range: participants took multiple drugs and injected themselves with insulin. Many were taking four or five shots of insulin a day. Besides the drugs they took to lower their blood sugar, they took pills for other medical conditions and to lower their blood pressure and cholesterol.
Does the way blood sugar is lowered make a difference?
In another article in the June 12, 2008, issue of the New England Journal of Medicine commenting on the discontinuation of the ACCORD study, the authors, Harlan M. Krumholz, M.D. and Thomas H. Lee, M. D., wrote “Clearly, the way in which risk factors are modified really does matter. Lifestyle interventions may have few risks, but we cannot assume the same for drugs – and drug-related risks are not always known or appreciated.”
Oral anti-diabetes drugs have side effects, among them: weight gain, hypoglycemia (low blood sugar), heart disease, digestive problems, liver inflammation, kidney disease, edema (swelling), and osteoporosis. Then there is the effect of drug interaction: ” ‘It might be that patients suffered unintended consequences from taking so many drugs, which might interact in unexpected ways,’ ” Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic was quoted as saying.
Another commentary on the ACCORD study was published in the April 9, 2008, issue of Nutrition & Metabolism. The title of this article was “Has carbohydrate-restriction been forgotten as a treatment for diabetes mellitus? A perspective on the ACCORD study design.” The authors, Eric C. Westman and Mary C. Vernon, wrote, “We believe that it is unlikely that the increased mortality [in the ACCORD study] was due to the tight glucose control but rather due to the particular method for trying to achieve it.”
They go on to say that there are other ways to improve blood glucose levels without the risk of hypoglycemic reactions and the other side effects of drugs; one of these ways will be the subject of next week’s article.
Mary Lou Williams, M. Ed, is a writer and lecturere in the field of nutrition. She welcomes inquiries. She can be reached at 267-6480.