Aggressive treatment of type 2 diabetes with medication can kill

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 [1]. 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.

References:

1. The ACCORD Study Group. Long-Term Effects of Intensive Glucose Lowering on Cardiovascular Outcomes. N Engl J Med 2011;364:818-828

7 Responses to Aggressive treatment of type 2 diabetes with medication can kill

  1. Kris @ Health Blog 10 March 2011 at 7:39 pm #

    I completely agree with you, I actually find it frightening to see how many drugs people are taking, especially older people.

    My grandmother for example is taking probably at least 10 different types of medication. Some anti-coagulants, some antidepressant, some diuterics, and a bunch of other kinds.

    And what’s even worse is that there is no single doctor monitoring all of this, she is prescribed one medicine from her lung doctor and another one from her cardiologist.

    I know the anti-coagulants are because she had a valve replacement some years ago, and she is not a very healthy person. But ALL of those drugs? I have a hard time believing that they’re doing her more good than harm.

  2. Robbo 10 March 2011 at 9:16 pm #

    Could you be more specific about the ‘aggressive treatment’ ? I guess it wasn’t a very-low-carb-diet, which could by some people be interpreted as ‘aggressive’.

  3. John Briffa 10 March 2011 at 9:22 pm #

    Robbo

    It was aggressive pharmacological treatment.

  4. Ronald Pottol 10 March 2011 at 10:13 pm #

    They gave insulin to control blood sugar in the first group, and since high insulin levels cause many of the problems, taking more is not really a win.

    http://www.proteinpower.com/drmike/cardiovascular-disease/ruminations-on-the-halted-accord-study/

  5. Nigel Kinbrum 11 March 2011 at 1:51 pm #

    Aggressive raising of blood glucose by eating the ADA & Diabetes-UK recommended high-carb diet combined with aggressive lowering of blood glucose by taking one or more medication(s) is asking for trouble. See The problem with Diabetes.

  6. Dan 14 March 2011 at 6:58 pm #

    A careful review of the ACCORD data shows that those in the intensive treatement group who actually achieved the lower A1C target did benefit. Those who tried, but didn’t acheive the lower target were the ones who had problems. Plus, it was the prescribed high carb diet with plenty of meds. Jenny at Diabetes Update has posted some analyses on this.

    http://diabetesupdate.blogspot.com/2011/03/no-virginia-lowering-blood-sugar-does.html

    http://diabetesupdate.blogspot.com/2010/05/accord-redux-its-high-blood-sugars.html

    http://diabetesupdate.blogspot.com/2009/07/accord-redux-low-a1c-does-not-raise.html

    http://diabetesupdate.blogspot.com/2009/03/when-doc-says-lowering-a1c-below-7-is.html

  7. pat Halling 29 April 2011 at 10:43 pm #

    my diabetic nurse at the clinic says if I do not take the following i will get very ill. I have diabetes 2. Metformin–4 a day—ramipril –1 a day—pioglitazone 1 a day . what should I do ?? I follow a very good diet ,I am a vegetarian. Meusli/Soya milk—watercress 2 eggs a day a mixture of vegetables daily. 3 glasses of red wine –\Camomile tea— indian tea –very little coffe.

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