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herbmcsidhe in diabeticpagan

Damned if you do, damned if you don't

http://seattletimes.nwsource.com/html/health/2004181346_diab14.html
Diabetes findings seem to be at odds
By Rob Stein

The Washington Post

WASHINGTON — One week after U.S. researchers said that pushing down blood-sugar levels as close as possible to normal might be dangerous for high-risk diabetes patients, a preliminary analysis of a similar international study has found no such risk.

The seemingly conflicting findings, released Wednesday, stoked the new uncertainty about the best strategy for treating type 2 diabetes, one of the most common health problems in the United States and elsewhere.



"This unfortunately just makes things more confusing," said Richard Kahn, of the American Diabetes Association. "I think patients will be confused. I think doctors will be confused. So I think the message is: 'Don't do anything until we get this sorted out.' "

Federal health officials said there were a variety of possible explanations for the differing findings, and they planned to meet with their counterparts at the international study to try to explain the results.

More than 21 million Americans have type 2 diabetes, which has become increasingly common because of the obesity epidemic. The disease causes blood-sugar levels to rise abnormally high, making patients prone to a variety of complications, including blindness, nerve damage, kidney failure, heart attacks and strokes.

Patients typically try to lower their blood sugar through diet and exercise or by taking drugs such as insulin or metformin, and researchers have long thought that getting blood-sugar levels as close to normal would be most beneficial.

But last week researchers at the National Institutes of Health surprised experts when they announced their preliminary analysis of a study involving more than 10,000 patients in the United States and Canada.

They found 54 more deaths in the group that had intensive therapy to lower blood-sugar levels than in the group that received standard treatment. The finding prompted organizers to halt the part of the study in which subjects were receiving the most intensive treatment.

The announcement about the U.S.-based study, known as ACCORD, prompted a panel monitoring a similar study known as ADVANCE to conduct a preliminary analysis of its data, which involve more than 11,000 patients in Europe, Asia and Canada, said study director Anushka Patel of The George Institute for International Health in Australia.

Like the ACCORD trial, the ADVANCE study involved patients at high risk for heart problems. The patients were 66 years old on average.

The ADVANCE analysis found no similar increase in deaths among patients receiving the most intense therapy for an average of five years, Patel said in a telephone interview.

"It's reassuring," she said.

She added that no additional information was available, including whether the study showed any benefit from more intensive treatment.

Other researchers said it was difficult to interpret the findings before seeing details of both studies, which have not been published. Although the two studies were similar, there may be important differences in the patients studied or the treatments they got, they said.

Comments

I work with someone in the ACCORD study
He is in the intensive side

They have been given numbers of deaths per 1000 but no one has said those numbers are DIRECTLY related to the tighter control

The only way I would think the extremely tight control would be an issue is if those deaths could be directly related to that control

If a person had a low sugar reaction and crashed their car, had body function failures or fell down a flight of stairs I could see something. The question would be, of the ones not in the intensive side, how many died due to complications directly related to higher sugars?

I was told when I was first diagnosed
VERY High blood sugars will kill you painfully 20 years from now
VERY Low blood sugars can kill you painlessly in 20 minutes

I would rather have slightly higher numbers, 100-140, and live 30 more years than slightly low numbers, 60-80, and have my body react to the insulin much better and put me under now