Misleading Headline Articles about Diabetes
Every time the results of some new study are reported with press releases to the popular press, we get a slew of stupid headlines that oversimplify, overstate, or simply misreport the results of the study.
For example, a recent study published in the Journal of the American Medical Association, known as JAMA, showed that a low-glycemic index diet worked a bit better than a "high fiber" diet, although the low-GI diet actually included more total fiber than the "high fiber" diet. Both diets were low fat, which means high carbohydrate, and low-carb diets were not tested.
Jenny's blog points out some of the problems with the study as well as providing a link to the full text.
But headlines in various publications include the following:
"High fibre diets bad for controlling diabetes, heart disease." No one said the high-fiber diets were bad, just that they weren't quite as good as the low-GI diet. And as noted, the diet with the slightly better results had more fiber than the "high-fiber" diet. But people reading that headline might start trying to avoid eating fiber.
"Low-glycemic diet best for diabetics, study shows." The study didn't show that the low-GI diet is the best, but simply that it's slightly better than another high-carb diet. They didn't study low-carb diets, but the headline implies it's best of all.
"Diabetes control better with low-glycemic index diet." This isn't quite as bad, but it doesn't say what it's better than.
Of course anyone reading the full article should be able to make up her or his mind about what the study really shows. But how many people read full scientific articles? How many physicians have the time? They'll simply see all the headlines, and similar ones in the medical magazines written for busy general practitioners, and come to the conclusion that low-GI diets are the best for people with diabetes.
One positive thing about all this is that it may help to nudge the American Diabetes Association into admitting that the GI has some utility. The ADA is about the only professional diabetes association in the world that hasn't accepted the concept of the GI.
But the bad thing is that the same people will think the low-GI diets are really the best, and they'll continue to persuade patients to avoid the low-carb diets that many patients have found to greatly reduce their A1c levels.
Recently, numerous research studies that show that low-carb diets can help people with diabetes without having bad effects on other parameters such as lipid levels. But mainstream nutritionists and nutritional researchers can't seem to get beyond the concept that fat is the cause of all our nation's problems. Maybe if we all ate less fat the economy would turn around?
Headlines in the past have been just as misleading as the ones I cited. Some years ago the Diabetes Prevention Program trial showed that prediabetic patients who lost weight with diet and exercise had a 58% reduction in progression to full-blown diabetes during the trial (some of them went on to develop diabetes later despite the weight loss and intensive instructions they received during the trial). All the participants were put on low-fat diets.
And headlines following the trial said things like
"Diabetes can be prevented with diet and exercise." Prevented? A 58% reduction isn't prevention. It's a reduction in incidence. It's like saying lung cancer can be prevented by outlawing smoking. Some people who never smoked will still get lung cancer.
"Diabetes prevented with low-fat diet." It's true that all the patients whose progression to diabetes was stopped or slowed down were on low-fat diets, because everyone in the trial was on a low-fat diet. It's possible that if some had been on low-carb diets, the progression to diabetes might have been reduced even more than 58%. But anyone reading a headline like that will naturally come away with the impression that low-fat diets are the best for diabetes "prevention."
A recent study in veterans is providing a lot of grist for the mills of headline writers. Researchers studied a group of veterans (average age of 60 years) who had had poor control (average A1c of 9.4) of their type 2 diabetes for an average of 11.5 years. Anyone with an A1c less than 7.5 was excluded from the study.
The vets were then assigned to "intensive" and "standard control" groups and followed for 8 years. The vets in the intensive control group then had A1c's averaging 6.9 and those in the usual treatment group had A1c's averaging 8.4, a good illustration of the well-known effect that simply being in a study has on many patients.
After 8 years, the number of cardiovascular events and deaths was almost the same in both groups.
One could interpret this study several ways: (1) BG control doesn't affect cardiovascular disease, (2) an A1c of 6.9 isn't low enough to affect cardiovascular risk, or (3) people who have had poor control for 11 or more years have already suffered damage from the high BGs, and close-to-normal BG levels won't reverse that damage.
Many headline writers are choosing explanation 1.
"Strict glucose control no help in cardio symptoms in type 2 diabetes." No mention of the 11 years of poor BG control.
"Strict blood glucose lowering won't ease diabetes heart risk." Same problem.
How many overworked GPs are going to read headlines like this and tell their recently diagnosed type 2 patients that there's no point being too strict about BG control: "Go ahead and eat all those Chrismas cookies because you're going to die of heart disease anyway"? I hope not many.
But sometimes, just to end on a positive note, the news people get it right. The Reuters report of the study was headlined
"Damage may already be done in advanced diabetes."
Right on, Reuters! That says it all, and in just a few words.
The American Diabetes Association, American Heart Association, and American College of Cardiology have issued a joint statement saying essentially the same thing: that for most people with diabetes, strict control is beneficial. For a few with pre-existing problems, it might not be worth the risks.
" ‘The lack of significant reduction in CVD events with intensive glycemic control should not lead clinicians to abandon the general target of A1C levels of less than 7 percent, and thereby discount the benefit of good control on what are serious and debilitating microvascular complications,' the joint statement concluded.
"However, for those who have a ‘history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, and those with longstanding diabetes in whom the general goal is difficult to attain despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose lowering agents including insulin,' less stringent A1C goals should be considered, according to the statement. Specific goals for people with these conditions should be determined by an individual's health care team."
Let's remember that "damage may already be done" tells us not to ignore our diabetes control on the theory that we can make up for it later. Good control is important at all times if we want to avoid suffering the consequences later.
However, even in this study of diabetes patients with poor control, although the better control didn't affect the mortality, after 8 years, about 80% of the patients in both groups were still alive.
Having diabetes, even poorly controlled diabetes, does not mean an immediate death sentence for the majority of patients.