The New York Times had a depressing story Monday: Diabetes Heart Treatments May Cause Harm.
The story described how several recent large clinical studies presented Sunday at an American College of Cardiology meeting showed no effects on heart disease in people with type 2 diabetes.
One study showed that reducing systolic blood pressure to 120 had no effect on heart disease. Another showed that reducing triglycerides and increasing HDL levels had no effect on heart disease. A third arm of this ACCORD study had been stopped earlier because the patients with the strictest control of (BG) levels had higher mortality rates than the "standard care" group.
A second study, NAVIGATOR, showed that reducing blood pressure with the angiotensin-receptor blocker valsartan (Diovan) or reducing postprandial BG levels with nateglinide (Starlix) had no effect on heart disease in people with prediabetes and preexisting heart disease or heart disease risk factors.
Sounds pretty hopeless, doesn't it. And I worry that people with type 2 will read the headlines and simply throw up their hands and give up.
But it isn't hopeless.
If you read the studies carefully (the full texts of the New England Journal of Medicine articles describing the ACCORD and NAVIGATOR trials are available free here, along with a couple of editorials that summarize the results), you can see why.
The study population in ACCORD was elderly, with multiple other health problems and poor control for at least 10 years. The participants in NAVIGATOR were prediabetic, but they had preexisting heart disease or several heart disease risk factors.
All the participants were given "lifestyle advice," meaning they were told not just to exercise more but to reduce fat intake, which invariably means eating more carbohydrate and then having to take more diabetic drugs to cover the high-carbohydrate diet.
What these studies really show is that you can't solve all medical problems with drugs. Because of the nature of these huge trials, it's impossible to know how many of the patients in the studies made any effort to improve their habits beyond trying to reduce fat intake and get more exercise. In many such studies, participants are advised not to change anything except the factors being studied, so the researchers will know if it's the drugs that are having the effect.
In that sense, the results of these studies are positive. We can't rely on drugs to cover our bad habits. It's up to us to take charge, learn what foods make our blood glucose (and our blood pressure and lipid levels) go up, and how exercise can make them go down.
And maybe the results will persuade physicians to stop drugging America and focus on listening to the patient and working together with the patient to come up with a healthy lifestyle that will control diabetes much better than drugs.
I've looked into these studies in more detail here.
Published On: March 16, 2010