Imagine this scenario: someone with type 2 diabetes and deemed to be at high risk of heart disease is consulting a doctor. What do you think the chances are of this individual ending up on multiple medications? High, I’d say. In all likelihood someone like this is going to be recommended to take at least one medication for their diabetes, a statin (even if cholesterol levels are normal), and at least one medication for blood pressure (even if blood pressure is normal). It’s sometimes comforting to be on a bunch pills for one’s ills, but is it always the best way? We might have some idea of the risks and benefits of single drugs taken on their own, but do we really have any idea of what they might do when taken as a cocktail?
By way of example, let’s take a look at the results of a study published this week in the New England Journal of Medicine . In this study, individuals with type 2 diabetes and high risk of heart disease were randomised to one of two groups:
1. aggressive lowering of blood sugar, aiming for an HbA1c (measure of blood sugar control over preceding 2-3 months) of less than 6 per cent.
2. not-so-aggressive lowering of blood sugar, with an HbA1c target of 7.0-7.9 per cent.
Actually, this part of the study had to be terminated early when it was noticed that those in the aggressively treated group were more likely to die compared to those who were less aggressively treated. I wrote about this at the time here.
The individuals in this study were followed up for some time, and now the study has been published which includes this follow-up period.
In short, here’s what it shows:
1. during the study, overall risk of death was 21 per cent higher in the aggressively treated group
2. This enhanced risk of death persisted in the follow-up period (19 per cent increased risk)
In summary: aggressive lowering of blood sugar with multiple drugs kills people compared to fewer/less medication.
This study should remind us that aggressive drug treatment is not always the best way. Sometimes in medicine, less can be more. See here for more about this.
1. The ACCORD Study Group. Long-Term Effects of Intensive Glucose Lowering on Cardiovascular Outcomes. N Engl J Med 2011;364:818-828