The People's Perspective on Medicine

New Research Poses Diabetes Dilemma

Maybe doctors could take a lesson from Goldilocks. In this nursery tale, Goldilocks didn’t like porridge that was too hot or too cold. She wanted it “just right.”

People usually relate to this fable because moderation seems to make sense. But many physicians believe in driving lab values down as much as possible, no matter what. A cardiologist friend likes to proclaim that no one can have too low a golf score or cholesterol level.

Diabetes doctors were disappointed recently when three studies showed that aggressive blood sugar control did not protect people with diabetes from heart attacks and other cardiovascular complications. In fact, one well-designed study (ACCORD) showed more heart attacks and deaths among patients who kept their blood sugar near normal (New England Journal of Medicine, June 12, 2008).

Such results defy conventional wisdom. Diabetologists expected that “tight” control of blood sugar would improve survival. The idea that it might lead to the very complications treatment is supposed to prevent is hard to accept.

And yet some previous studies have produced similar results. In 1970 the results of the University Group Diabetes Program shocked physicians. This study was the most ambitious diabetes trial at the time, but patients who received the oral diabetes medication tolbutamide (Orinase) had a higher rate of cardiovascular death than patients on placebo or insulin.

Soon after that, British researchers recruited thousands of diabetic subjects to a ten-year study. Those who received “intensive” drug therapy to lower blood sugar did not have fewer heart attacks, strokes or deaths (Lancet, Sept. 12, 1998).

When doctors treat numbers instead of patients, they may overlook complications of the therapy. In the ACCORD trial, many of the subjects treated aggressively gained weight, some as much as 20 pounds. Others experienced symptoms associated with lowering blood sugar too much (hypoglycemia). These can include dizziness, weakness, anxiety, sweating, shakiness, palpitations and confusion. Severe hypoglycemia can be life threatening.

Where does this new research leave patients with type 2 diabetes and their physicians? If this disease is left untreated, it increases the risk for many serious health problems including kidney disease, blindness, nerve damage, heart attacks and strokes. Clearly, doing nothing is unacceptable.

But aggressive treatment may have the unexpected outcome of causing some of the very cardiovascular complications it is intended to prevent, which leads us back to the story of Goldilocks. Getting the porridge just right takes some effort.

Keeping blood sugar neither too high nor too low requires careful management. The role of exercise, diet, blood pressure and cholesterol control must not be overlooked.

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    About the Author
    Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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    I’m a Lipitor Diabetic. The CDC has thousands of us for whom the doctors said nothing about our medications raising blood sugar. My HMO does not allow people with a diabetes diagnosis in their files see an Endocrinologist. The medications my doctors had me on raised my blood sugars to 240 or more. I wasn’t above 99 to 110 before the Lipitor! Should I take massive amounts of Insulin or stop taking the Medications?! Some Dilema!!!!!!!!!!

    I recall a very large study begun several years ago which was abandoned when, about half-way through, it was determined that diet and exercise alone were absolutely able to control Type 2 diabetes. In other words, if you are serious about controlling your blood sugar and willing to make the necessary life-style changes, you can do it, and thereby avoid the cost and side effects of medication. That’s what I’m doing.

    I am an insulin dependent type 2 diabetic. I am able to maintain a much tighter range of blood glucose in the time I have been using insulin than I ever was on oral medications alone. I have had a pump for almost five years and my current a1C is 6.0. I do not have significant highs or lows because I pay attention and check my blood glucose often. I believe just telling patients to lower their blood sugar without telling them how to do it safely is counterproductive.

    I’m very sorry about the “results” of these tests regarding Type II Diabetes. It leads one to think—“should I try to lower my blood sugar?”—-or should I just let my blood sugar do “it’s thing”???
    If lowering your blood sugar does nothing to prevent heart attacks, and other complications———-then, why bother??? I do take meds to keep my blood sugar at a reasonable level—-110 to 130—but this article confuses all of us with “their results”.

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