Diabetes UK CEO urges diabetics to manage their cholesterol levels better, but is this advice based on good evidence?

Baroness Barbara Young is the chief executive of the charity Diabetes UK, the UK’s largest and most prominent diabetes charity, and an organisation which encourages diabetics to eat at every meal foods which are known to be disruptive to blood sugar levels and therefore be bad for diabetics (go figure). You can read more about this here and here.

Baroness Young has been on somewhat of a media blitz recently, raising awareness of the ‘need’ for diabetics to have their cholesterol levels managed, including with drugs. Here’s a typical story on the BBC website, which includes this quote from the Baroness:

It will often be appropriate to prescribe medication such as statins, but it is no good doing this without explaining the importance of taking the medication regularly and the potentially devastating consequences of not doing so.

Baroness Young’s charity is not known for the evidence-based nature of its information and advice, and I decided to see if her urging diabetics to manage their cholesterol properly is scientifically supported.

I came across a pertinent review of this subject published earlier this year [1]. The authors of this review assessed studies in which cholesterol-lowering drugs were used in individuals with diabetes. They excluded studies which had been terminated early for no good reason (early stopping of studies is known to exaggerate the benefits and reduce the apparent harms of a treatment), and well as studies in which the participants were not properly ‘randomized’ (which effectively means that the underlying characteristics of those on the medication and placebo were not equivalent, which in turn can give misleading results).

Four trials were left: three in which a statin was the drug being tested [2-4] and one which tested the effects of a fibrate (another type of cholesterol-lowering drug) [5].

Here’s a brief summary of the results of each of these studies.

Study [2]: A reduction in risk of major cardiovascular events (e.g. heart attack or stroke) of 37 per cent but no reduced risk of death overall.

Study [3]: No reduced risk of a ‘composite endpoint’ encompassing a variety of outcomes including death from heart attack or stroke, non-fatal heart attack and stroke, and coronary artery bypass surgery. No reduced risk of death overall.

Study [4]: No reduced risk of a composite endpoint made up of cardiovascular death as well as non-fatal heart attacks and strokes. No reduced risk of death overall.

Study [5]: No reduced risk of fatal and non-fatal heart attacks. No reduced risk of death overall.

The authors of the review conclude:

This review does not support the use of cholesterol-lowering drugs (such as statin and fibrate) to reduce mortality and cardiovascular complications in type 2 diabetics.

The authors suggest that the guidelines regarding cholesterol management in diabetics have been corrupted somewhat by the conflicts of interest some advisors have by remarking:

Official guidelines should be re-examined and reformulated by experts independent from the pharmaceutical industry.

 

Sound like a good idea to me. And it reminded me that Diabetes UK has conflicts of interest of its own in the form of corporate sponsors in the form of drug and food companies. See here for a full list.

References:

1. de Lorgeril M, et al. Is the use of cholesterol-lowering drugs for the prevention of cardiovascular complications in type 2 diabetics evidence-based? A systematic review. Rev Recent Clin Trials 2012;7(2):150-7

2. Colhoun HM, et al; CARDS investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364(9435):685-96

3. Knopp RH, et al. Efficacy and safety of atorvastatin in the prevention of cardiovascular end points in subjects with type 2 diabetes: the Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in non-insulin-dependent diabetes mellitus (ASPEN). Diabetes Care. 2006;29(7):1478-85

4. Wanner C, et al, for the German Diabetes and Dialysis Study Group. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 2005; 353:238-248

5. Keech A, et al; FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005 Nov 26;366(9500):1849-61

7 Responses to Diabetes UK CEO urges diabetics to manage their cholesterol levels better, but is this advice based on good evidence?

  1. pia Houmoeller 14 September 2012 at 11:15 am #

    thanks for a very important post.
    The statement “Study [2]: A reduction in risk of major cardiovascular events (e.g. heart attack or stroke) of 37 per cent but no reduced risk of death overall” seems to me to be a very good reduction, eventhough the overall rate of death was not affected.
    I am aware that this is only one study but having in mind that diabetes increases the risk of getting heart-disease a lot, is this not good results?

  2. George Cooper 14 September 2012 at 1:31 pm #

    Diabetes UK sponsored by shredded wheat, a high GI breakfast cereal… amazing

  3. Eddie Mitchell 14 September 2012 at 4:56 pm #

    Thank you Dr. Briffa for another excellent article. DUK trots out rehashed articles every few weeks. Anything to get the newspaper headlines, anything to keep the cash rolling in, anything to keep their big pharma and food company sponsors happy. Unfortunately they have trotted out the same ludicrous dietary information for years. Their carbohydrate recommendations border on the criminal in my opinion, and are a complete disgrace. Nothing illustrates the DUK lack of progress better than the NHS audit statistics below.

    Results for England. The National Diabetes Audit 2010-2011 
    Percentage of registered Type 1patients in England
    HbA1c >= 6.5% (48 mmol/mol) = 92.6%
    HbA1c >   7.5% (58 mmol/mol) = 71.3%
    HbA1c > 10.0% (86 mmol/mol) = 18.1%

    Percentage of registered Type 2 patients in England
    HbA1c >= 6.5% (48 mmol/mol = 72.5%
    HbA1c > 7.5% (58 mmol/mol) = 32.6%
    HbA1c >10.0% (86 mmol/mol) = 6.8%

    These pitiful results are very similar to those obtained in previous NHS audits over the past 5 – 6 years. As you can see these are percentage figures. The actual total number of diagnosed diabetics over the last five years has escalated greatly, and continues north by the day. Would you treat an alcoholic with more booze, or a drug addict with more heroin ? Meals and recipes based on starchy carbs are the last thing a diabetic needs. DUK must know this. Recommending a safe and cost effective lowcarb diet and exercise regime, with nil/minimal medications would have many DUK sponsors withdrawing support.

    With the massive financial cut backs within the NHS, and the ever growing epidemics of obesity and its often linked type two diabetes, something’s got to give. The NHS is restricting certain expensive type two medications, (others have been banned for killing people) and test strips for type two diabetics, countries such as Greece are dangerously low on diabetes medications and other drugs. Maybe, just maybe, Doctors everywhere will soon be promoting a lowcarb diet by default, because dwindling finances and lack of drugs will be their only option. Albert Einstein said, Insanity: doing the same thing over and over again and expecting different results. While the madness continues, nothing will change.

    Keep up your great work John, you are part of a growing number of healthcare professionals who are questioning the bent science, and recommending a change in diet and lifestyle before statinating your patients, and turning them into drug dependent zombies.

  4. Sarah 14 September 2012 at 11:49 pm #

    I suggested to my type 2 diabetic relative to look at your article on Diabetes UK links with food and pharmaceutical companies. My suggestion was dismissed out of hand as she gets all her information about how to manage her condition from Diabetes UK magazine ‘Balance’. Yes, she is also taking a stain. *Sigh*

  5. PhilT 15 September 2012 at 12:20 am #

    If Diabetes UK is stuck in a lipophobic rut it would explain why they advocate high carb diets = low fat diets. Shame it pushes their clients towards the most unsuitable macro-nutrient for their condition, carbs.

  6. PhilT 15 September 2012 at 12:51 pm #

    The NHS diabetes audit found that “Deteriorating glycaemic control is not being recognised or addressed leading to serious complications. A change in culture is needed.” – so perhaps getting to grips with the disease of diabetes rather than going off-piste onto cardiovascular disease and lipidaemia should be a priority for Barbara Young. The same audit had to withdraw its HbA1c data due to errors and is due to republish at the end of the month. I can’t imagine that’s going to be pretty.

    http://www.ic.nhs.uk/webfiles/Services/NCASP/audits%20and%20reports/7.National_Diabetes_Inpatient_Audit_2011_FINAL_INTERACTIVE_PDF.pdf

  7. Dan 17 September 2012 at 11:43 pm #

    As a diabetic here in the USA, I’ve been pressured to take statins. I looked at the study data myself and found that there is no conclusive benefit to preventing heart attacks or extending life for diabetics who have not had a heart attack. It’s more of a money making thing. It’s good to see some published analysis.

    BTW, when they say 37% improvement, that is relative risk, which is deceptive. They take the absolute difference and divide by the original value. The CARDS study showed about a 37% relative risk reduction in events, but the absolute difference was only 4%. Not very impressive.

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