DOCTORS ARE SHOCKED BY ACCORD DIABETES STUDY RESULTS OF VERY TIGHT BLOOD SUGAR CONTROL AND THEY HALT PART OF DIABETES STUDY

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Doctors are perplexed by the results of a medical trial to improve the health of people with type 2 diabetes. Diabetes complications come from high blood sugars. Lowering blood sugars is one of the mantras of diabetes care. It seems to work. So doctors figured if lowering blood sugar some what helps than how about lowering blood sugar even more. The lower the better right? Now the shocking results of a diabetes study have opened the question is there such a thing as too low. In the ACCORD medical study to lower diabetes complications doctors employed a medical strategy to intensively lower blood glucose (sugar) below current recommendations. In a shocking development that is hard to explain, "the medical strategy to intensively lower blood glucose (sugar) below current recommendations increased the risk of death compared with a less-intensive standard treatment strategy. "People with diabetes should never adjust their treatment plan or goals without consulting their health care providers."




"The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has stopped one treatment within a large, ongoing North American clinical trial of diabetes and cardiovascular disease 18 months early due to safety concerns after review of available data, although the study will continue.

Read about a study that suggest most diabetics should consider cholesterol lowering statin drugs





The intensive treatment group had a target blood sugar goal, measured by hemoglobin A1C, of less than 6 percent.This is similar to blood sugar levels in adults without diabetes. Hemoglobin A1C or glycosylated hemoglobin is a measure of blood sugars over several months. When sugar is high in the blood a lot it sticks to the red blood cells and can be measured in the hemoglobin A1C. So the hemoglobin A1C test is better than just a random blood sugar to get an idea of long term blood sugar. The standard treatment group in the ACCORD Study aimed for a target similar to what is achieved, on average, by those with diabetes in the United States (A1C of 7 to 7.9 percent) and lower than at study entry.

Also read about people with diabetes possibly benefiting from ACE blood pressure medicines even if they don't have high blood pressure



"It’s confusing and disturbing that this happened,” said 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,” he added." People with diabetes should never adjust their treatment plan or goals without consulting their health care providers.



"The ACCORD findings are important, but will not change therapy for most patients with type 2 diabetes. Few patients with high cardiovascular risk like those studied in ACCORD are treated to blood sugar levels as low as those tested in this study, " said Judith Fradkin, M.D., director, Division of Diabetes, Endocrinology, and Metabolic Diseases at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)."People with diabetes should never adjust their treatment plan or goals without consulting their health care providers."

For Safety, NHLBI Changes Intensive Blood Sugar Treatment Strategy in Clinical Trial of Diabetes and Cardiovascular Disease

Diabetes Study Partially Halted After Deaths

SHOULD ALL PEOPLE WITH DIABETES USE BLOOD PRESSURE PILL ACE INHIBITOR EVEN WITH NORMAL BLOOD PRESSURE ACE INHIBITORS HELP DIABETIC KIDNEY PROBLEM

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Should all people with diabetes take a blood pressure pill ACE inhibitor? Blood pressure pills with names like lisinopril, captopril,etc are used to treat other things beside blood pressure. ACE Inhibitors are known to reduce kidney problems in diabetics.There are two main types of diabetes. Type 2 diabetes is more common and tends to occur in older adults(but can happen in kids too). The problem in Type 2 diabetes is frequently "insulin resistance". Your pancreas may produce insulin but your body does not respond properly (resists) to the insulin. In Type 2 diabetes, the body has trouble using insulin, even if it is available.



Your brain needs a constant supply of blood glucose(sugar). Not enough glucose to the brain and you faint. Too much glucose circulating in the blood and you feel sick. The job of regulating blood glucose depends on a Yin and Yang relationship of two hormones. Insulin drives sugar from the blood into the cells of the body. Glucagon helps to increase sugar in the blood.

Symptoms of diabetes can include:

increased thirst or hunger

fatigue and weight loss

increased urination, especially at night

blurred vision

sores that do not heal





Among the complications of diabetes is kidney trouble a.k.a diabetic nephropathy. Many diabetic people have high blood pressure. So doctors often prescribe a blood pressure pill. Ace inhibitors are a class of blood pressure pills with names like lisonopril, captopril, enalapril, benzapril,etc. Ace inhibitors treat many things besides blood pressure,migraines,for example. ACE inhibitors block the enzyme ACE in the body from producing angiotensin II, a chemical that does things like narrow blood vessels and cause sodium retention.




"We know that ACE inhibitors slow the progression of diabetic kidney trouble (diabetic nephropathy). So they’re indicated for that, they’re indicated for hypertension why not just put all diabetics on them?" In other words doctors wonder should all people with diabetes be on an ace inhibitor blood pressure pill to protect their kidney even if they don't have a diagnosis of high blood pressure.

Read this article suggesting that perhaps most people with diabetes would benefit from certain cholesterol lowering medication



In this article in the medical journal The Lancet, researchers report about putting patients even without a diagnosis of high blood pressure on a fixed dose combination of ACE inhibitor and diuretic.The results were that diabetics who were on ace inhibitors and a diuretic (water pill) did better. "We assessed the effects of the routine administration of an angiotensin converting enzyme (ACE) inhibitor-diuretic combination on serious vascular events in patients with diabetes, irrespective of initial blood pressure levels or the use of other blood pressure lowering drugs".




The findings:



"The relative risk of death from cardiovascular disease was reduced by 18%… and death from any cause was reduced by 14%. Although the confidence limits were wide, the results suggest that over 5 years, one death due to any cause would be averted among every 79 patients assigned active therapy".

Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial

Simplifying Management of Type 2 Diabetes