dLife CEO Responds to the NY Times
That clacking noise heard around the world yesterday was the sound of millions of people with diabetes putting their blood glucose monitors back on the shelf, relieved to know that the dogged pursuit of tight blood sugar control is no longer necessary. That is, if you read the first paragraph of Thursday’s front page New York Times article on the recently halted arm of the ACCORD study: "For decades, researchers believed that if people with diabetes lowered their blood sugar to normal levels, they would no longer be at high risk of dying from heart disease. But a major federal study …found that lowering blood sugar actually increased their risk of death." This is an exceedingly dangerous takeaway. The bigger story here is what the presentation of this news, not the news itself, tells patients about managing their diabetes appropriately.
Coverage from the Times and others implied that based on this development, you should rethink the pursuit of tight control – and that’s flat out wrong. Other long-term, large-scale studies, including the UKPDS and the DCCT, have conclusively demonstrated that tight control leads to a lower incidence of most diabetes complications. The portion of the ACCORD study the Times reported on looked at a very specific subset of people with type 2 diabetes who had pre-existing and severe cardiovascular risk factors. To extend those conclusions to a population of over 20 million Americans struggling with diabetes for the sake of a headline is a dangerous disservice to all.
Other media outlets didn’t fare much better. Take for example Wednesday’s NBC Nightly News, where Dr. Steven Nissen of the Cleveland Clinic said “lowering blood sugar to a lower level may actually increase mortality for some patients.” That seemingly harmless sound bite, perhaps pulled out of context, provides an excuse for the millions struggling with diabetes management to pull back and rationalize that they may not need to be as diligent as they thought.
I have diabetes, and so do the millions of people dLife reaches through our TV show and website. All of us are extremely challenged by the daily, constant grind of managing our lives to maintain good control. Every day we face a physical, emotional, and psychological battle with the encroaching monster of complications – including heart and kidney disease, blindness, amputation, or death – and our only weapon is vigilant blood sugar management. Now the media’s simplistic reporting on the ACCORD study findings may result in adverse outcomes for many who are lead to believe that even this is not enough.
Let’s step back and take a dose of some common sense. If you can get your blood sugar closer to that of a non-diabetic, it must be better than being out of control with higher blood sugar. The collective and individual uphill struggle to get diabetes under control can’t pause for what is now simply an interesting and developing research story.
Howard Steinberg
CEO
dLife - For Your Diabetes Life
Comments
- At 12:56 AM on Wed, Apr 2, 2008 JasonJayhawk wrote:
Thanks for keeping on top of this. The ACCORD study is just what insurance companies want to hear because they'd just like to pay for the complications rather than the preventative maintenance. (Isn't that how a lot of people think about their cars?)
- At 12:31 PM on Mon, Feb 18, 2008 Chuck Keyser;ing wrote:
The sad thing about the media's coverage is that they didn't point out that both groups did better than others not getting treatment so controlling glucose/A1C is VERY important and getting it under 7.0 as the ADA recommends will prevent or delay complications. Meeting tight control guide lines is still the best control for type-1s, and that doesn't mean that one has to have an A1C less than 6.0 as the intense treatment group was aiming for.
Another important thing is that large studies are general in nature and getting specific guidance for you from your doctor is right way to best control your diabetes.
- At 06:36 AM on Sun, Feb 17, 2008 sadaf sultana wrote:
i am a 44 years old pakistani female with type 2 diabetes diagnosed in august,o7 with recent a1c of 6. websites like this have been my source of strength and effort to control my blood sugar and helped me lose 22 pounds in the last 6 months.i am controlling my sugar levels through diet and execise alone and i know i still have to lose weight and eat less carbs( whole wheat bread known as roti is us pakistani's staple diet which i take 3 times a day and that is creating problems). i wish to have a similar community develope here in pakistan to educate and support each other.
i would like to be sure if a1c of 6 is considered non diabetic/normal or should i take it to 5 to make it to 5% club.regards
sadaf
karachi, pakistan - At 04:35 PM on Fri, Feb 15, 2008 Mark Dustan wrote:
My take away from the atricles about the potential issues of trying to drive Blood sugar to the levels of those w/o dibetes, was not to put away my blood sugar monitor. I felt it was a wake up call for Doctors, endrocrinogists, and Diabetes educators that one size DOES NOT fit all and there is just one recipe for those of us with Diabetes. Every time the health plan changes doctors, they all go back to the one treatment for Diabetes. I have been on every regiment from oral medications to insulin to byetta, virtualy nothing gets it to the newly established levels considered healthy, in fact even with careful control of diet and exercize, most of the medications do exactly the opposite than advertised. Things like weight gain for virtually all of the medications and many negative side effects like elevated blood pressure and cholestral from taking the current medications. It is a shame that medical experts still insist that forcing diabetics to get down to under 6 on the A1c scale by using the old theories. Most of us have to live with the side effects that doctors neglected to list when we were forced to use the "old recipes. I hope this is a wake up call for the Doctors that one size does not fit all. I expect they are getting hundreds of calls about the outcome of thestudy. I hope it is a wakeup call for them!
- At 10:04 AM on Thu, Feb 14, 2008 Charles Keyserling wrote:
The study showed that lower A1C numbers led to lower death rates in both test groups over at risk people with POOR control. The test showed under certain conditions going lower would increase death rate, but the cause has not been identified.
Tight control for type-1s has been proven best, but that is not necessarily true for all type-2s with insulin resistance. The control in the intense group that was stopped was tighter than what is normally conssidered tight control and it is not clear that any other test has shown that diabetics getting mormal A1Cs is best. Risk of lows in some diabetics may make getting a normal A1C more risky than an A1C goal closer but lower than 7.0. In any case getting your A1C below 7.0 as recommended by the ADA will clearly lower the odds of complications.
Chuck
- At 02:03 PM on Tue, Feb 12, 2008 Bill Arnold wrote:
Am U wrong in believing that too many doctors do not know what they are talking about? I stay confused when so many times an announcement is made that these things we have preached to you about are wrong? I really am to the point I don't pay a lot of attention to what they say. I keep on exercising, I keep eating the things I was raised on and I have no doubt about how I'm handling my diabetes,
- At 07:37 PM on Sun, Feb 10, 2008 David Camara wrote:
I Know the more I test, the better my numbers are and the better I feel. This is the problem with people taking medical research out of context and mis quoting them.
The New York Times can print all it wants, I know what works for me. What works for me may not work for anyone else but it is a system that at this point in time is working best for me.
The Times does not allow for all those newly diagnose diabetics and those still have trouble couping with thier condition and are only too ready to jump on a report stating they can stop or back off thier Dibetes regiments.
Will it take a large number of Deaths associated with reports like these to get News Bureaus to give more responcibility to thier reporting?
- At 11:16 AM on Sat, Feb 9, 2008 Kim Angelides wrote:
Thank you Howard for putting a more balanced perspective into this new "media" event. As providers we take seriously any claims but they must be looked at in the context of 1. the study itself and 2. the impact on our patients. First the study focused on cardiovascular risk and there are, to say the least many confounding variables in this study. It was not a study of tight control, but a study of the CV risks of control under Hb1Ac 6%. Second, these type of non peer reviewed comments are not particularly helpful given that it is well documented that those who have good control, and have consistent (emphasis) Hb1Ac levels and blood glucose levels stem the complications from diabetes. And last as a side commment, those with other risk factors that are under 6% Hb1Ac and are insulin dependent, it is indeed introduces an additional risk given that there may be significant excursions and lows to get to those levels. I would agree with Howard that a more balanced and common sense approach is necessary and until this is fully vetted scientifically with all the confounding variable accounted for, this should be looked at as only interesting.
On Sunday April 20, 2008 60 Minutes had a segment on a surgical procedure which cut obese patients' stomachs by 3/4 and bypassed their small intestine (if I remember correctly) in order for them to lose weight. Every one of the patients had diabetes before the proceedure. After the proceedure the patients lost 1/3 of their weight and every one of the patients had their diabetes cured immediately! They attribute the cure for diabetes to bypassing the duodenum (sp?)After the proceedure the patients were still quite overweight (a LOT more than myselkf).