I've recently seen stories reporting that 1. Avandia, used to lower blood glucose (BG) levels, which should reduce cardiac risk, increases cardiac risk. 2. Vytorin, used to lower cholesterol levels, which should reduce cardiac risk, increases cardiac risk. 3. In...
Avandia, Vytorin, and now the ACCORD diabetes study: What's going on here?
2/ 7/08 9:40pm
When I saw the Accord item in USA Today, I went to their website to read something of what they are doing with the patients. It indicates that in addition to drugs to lower blood glucose levels, they are giving diet recommendations. The diet is probably the low fat, high carbohydrate diet supported by the ADA. Having recently read Good Calories, Bad Calories by Gary Taubes, I'm convinced that diabetics must limit their carbohydrate intake and remove refined carbohydrates from their diets. On page 190 of his book there is a possible explanation for what they saw in the Accord trial. If the patients continued a high carbohydrate diet and increased their medications, they would be producing or injecting more insulin to lower their A1c. Taubes points out that in a 1960s study Robert Stout of Queen's U. in Belfast reported that insulin enhances the transport of cholesterol and fats into the cells of the arterial wall and stimulates the synthesis of cholesterol and fat in the arterial lining. This would explain why lowering your A1c with diet is safe but with added medications is suspect.
2/ 8/08 10:07am
I don't think it makes sense to speculate on the cause of the higher coronary deaths in the intensively treated patients in this trial until we get all the facts.
If the tight-control group was told to cut back on fat more than the standard-treatment group was, this would mean they ate more carbs, and that could be a factor.
But we won't know this until the details are released.
In the meantime, there are a few things that should be kept in mind.
According to an article in The Wall Street Journal, "The patients in the study did better than similar people who weren't part of the research. In the community, diabetics with similar risks have an annual mortality rate of 4-6%, according to one of the researchers. The
intensive treatment group had an annual mortality rate of 1.4%, compared
with a rate of 1.1% for the standard treatment group in the study."
In other words, deaths in both groups were down about 3 to 5% compared with diabetic patients of their age and risks in general. But the difference between standard treatment and tight control was only 0.3%.
Dr William Friedewald, chair of the ACCORD steering committee, also noted that nonfatal heart attacks were reduced by 10% in the tight-control group. But when patients in this group did have a heart attack, it was more apt to be fatal. The tight-control group also had more "unexpected sudden deaths."
2/ 8/08 11:56am
I am really pleased you took the time to write your opinion on all the controversies. Makes me think "ain't life a b----". It's so disconcerting to get so many varying responses that I almost think, maybe they're on to something.
Consider: diabetes is a disorder/disease of the metabolic system. Our bodies no longer handle the processes automatically. It could be that adjusting our bodies with exercise, diet, and medications is the less optimum way to regulate insulin levels and glucose. By keeping blood levels extremely low via the medications, foods, and exercise we still have not fixed the root cause. These "mechanical" adjustments are not precise nor are they immediate. Personally, I think I will eat a bit more or take a tiny bit less medicine to be sure I maintain an average of 120 to 125. I love Avandia and it has done much to control my high blood sugars, sometimes too well. I have more lows than ever before and I have to monitor my glucose much more closely than in the past. Five minutes of exercise can plummet my numbers so I eat before I exercise. Reducing my portions as part of a weight control effort has also lowered my levels considerably. I'm thinking the extreme lows I see at times are not so great....nor even levels such as 89, 75, 94 etc. when we do not have the ability to make adjustments instantaneously, as our bodies did before we were diagnosed as diabetic. Lack of immediate precise adjustments may be part of the problem when we keep our glucose levels too low.
Gayle from Georgia
2/14/08 3:29pm
How many times have we seen new drugs on the market that are quickly pulled from the market due to unexpected side effects. I do not trust new medications, even over the counter stuff. Certainly there is a need for medications, but I prefer to start with the tried and true.
It is the drug companies that push the newest and "best" to the doctors who may or may not use it in place of the old reliable. The FDA needs to take more time in long term research. Just listen to the drug adds and the list of side effects from them. The side effects cause worse maladies than what they are trying to cure.
All I'm saying is that unless your have tried everything that's come before it to no avail, then skip the new, unproven stuff.
Featuring Content From:
By using this service, you accept our Terms of Use. Please read them. The consumer health information on is for informational purposes only and is not a substitute for medical advice or treatment for any medical conditions. You should promptly seek professional medical care if you have any concern about your health, and you should always consult your physician before starting a fitness regimen. Copyright © 2012 Remedy Health Media, LLC. All Rights Reserved.
I agree I spoke to my doctor about the story on Vytorin she said the trial was from 700 people and to continue taking Vytirin.
Mary