The Media Blows it Again
Usually a trusted source of medical analysis, The New York Times has really blown it this morning in their analysis of yesterday's developments in the ACCORD trial. In one paragraph, health care writer Gina Kolata sets back diabetes education at least a decade by opening her NYT piece with the following sensationalized - and simplistic - analysis:- "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 of more than 10,000 middle-aged and older people with Type 2 diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported Wednesday."
Comments
- At 11:20 AM on Mon, Feb 11, 2008 Lucy wrote:
This will cause a lot of confusion for a lot of diabetic patients thinking it is ok to keep their blood sugars in dangerous ranges.
Recently there was another media frenzy that spoke to the fact that caffeine actually made blood sugars worse. Wasn't it not too long ago that caffenine was in the news with regards to it cutting diabetes risks?
I just don't know what to believe any more!
- At 09:44 AM on Sat, Feb 9, 2008 jv wrote:
the media is good at getting their information wrong,im a type 2diabetic,i watch my diet im on metformin my husband is also a type 2 diabetic that was just depending on the drug metforminto controlit well his blood sugars went out of control, and he is now on insulin.diet and exercise play a big part in the control that you have
- At 04:30 PM on Fri, Feb 8, 2008 chenghua kerr wrote:
Thank you so much for this info. I didn't even know aobut this 'til I open your e-mail. Thanks again.
- At 04:16 PM on Fri, Feb 8, 2008 Jay Ludwig wrote:
If the media got it right, that would be news! Getting it wrong, sensationizing and biased reporting is an everyday thing-not news.
- At 01:41 PM on Fri, Feb 8, 2008 Lil Tibus wrote:
I am a Type 1 diabetic for 62 years. I wouldn't have attained this without tight control. I am also very busy being physically and mentally active and enjoying life to the fullest, WITHOUT complications.
L.T. Lakewood, NJ
- At 11:29 AM on Fri, Feb 8, 2008 kinget wrote:
Doesn't surprise me a bit. Last week they really blew it with an article on fibromyalgia that was really a rant against pharmaceutical companies. They made it sound like this very painful condition was just a madeup disease to allow drug companies to increase their sales. I used to have a lot of respect for the Times, but not any more. Of course, my local TV news was jumping on the bandwagon with the ACCORD story, so I was muttering back to the TV last night, too.
- At 11:04 AM on Fri, Feb 8, 2008 Bernard Farrell wrote:
There's been a lot of spin about this in the media and huge amount of corrections and clarifications in the diabetes blogosphere. Go to the diabetes search engine and look for "ACCORD trial" for more useful reading.
Has anyone contacted Gina K. directly and asked her to write a correction? That might be a good place to start.
- At 08:45 PM on Thu, Feb 7, 2008 Chris wrote:
Perhaps these results can best be explain by insulin. The people who were most aggresive at controlling blood sugar were taking 5-6 insulin shots a day. Insulin is known to have negative effects on enothilial function. This whole thing might be retitled - Group with highest insulin levels experienced highest rate of coranary artery disease.
If true, this would suggest optimum health could be obtained on a low carb diet that minimized blood sugar levels, and required that least amount of insulin.
From Dr. Richard K. Bernstein author of the Diabetes Solution, Diabetes Diet and the Secrets to Normal Blood Sugars.
The question is really, was the claim made by the NIH that “lowering blood sugar actually increased the risk of death” a valid claim and if not, what was really going on? Well, what I maintain is that the problem was in the treatment, not in the fact that blood sugars were lowered. When this study was started, the ADA very clearly mandated 60% to 65% dietary carbohydrate for diabetics. This high carbohydrate diet forced the use of industrial doses of insulin, large doses of sulfonylurea drugs and very possibly at the very least a hazard for hypoglycemia; and a great likelihood of rollercoaster blood sugars as we usually see in diabetics who are put on a high carbohydrate diet. So it looks like the likely high carbohydrate diet was at the core of the problem. Now, aside from the impossibility of real blood sugar control and indeed, although the Gina Colata article in the New York Times claims that the blood sugars were very low. They weren’t. They did not get below 6% on the A1C.
Six percent corresponds to an average blood sugar of 140 mg/dL. So the blood sugars were still quite high. What hazards were introduced? Well, first of all, we know from a number of studies that high carbohydrate diets tend to increase rather than reduce cardiac risk factors. But in this case, probably much more significant was the likelihood of weight gain. We use low carbohydrate diets to reduce weight. So if you’re going to give them high carbohydrate diets and large doses of insulin to off set the resulting high blood sugars, you’re going to be building fat. And doing that to someone who’s already at high cardiac risk is just adding to their burden, probably adding tremendously. In addition, there’s been a lot written about the adverse effects of high serum insulin levels, principally, on the vasculature. For example, high serum insulin levels increase vascular leakage, cause pathologic proliferation of the vascular endothelium, arterial stiffening, and hypertension. In addition, the obesity also exacerbates hypertension. So if you’re making people fatter, you’re making their hypertension worse.
On the other hand, there have been articles pointing out that for insulin deficient individuals, if you put them on insulin, you facilitate vascular repair. So there’s a balance. Small physiologic blood levels of insulin help the vasculature whereas these industrial blood levels of insulin are harmful for the vasculature. So simultaneously, you’re increasing hypertension, you’re making them fat and you’re causing vascular damage in a number of different ways just from the high carbohydrate and the high insulin.
So the conclusion that the study should be terminated perhaps should have been replaced with a revamping of the study so that the treatment would be changed to mandate very low carbohydrate diets and physiologic instead of industrial doses of insulin. One other point to remember is that high doses of insulin combined with high carbohydrate cause the rollercoaster effect. If you take a type 2 diabetic who already has cardiac disease, and you put them on the rollercoaster blood sugars, up and down, and up and down, you’re not doing his heart any good.
A similar situation occurred in the DCCT trial in the intensive arm, more hypoglycemia. I wrote an article that was published in the American Journal of Medicine, after the DCCT. They were complaining that they had so much hypoglycemia, even at A1C’s of 6% and they didn’t get below 6%, but approaching 6% they got more and more severe hypos. I pointed out the laws of small numbers wherein high carbohydrate plus high insulin causes unpredictable blood sugars..
Items missing in the NIH press release included what sort of diet they were on and which oral medications they were using. I’d be very foolish if they were put on a low carbohydrate diet. I’m willing to bet that they were put on an ADA diet and it was probably very high in carbohydrate.
I am assuming that they used high doses of insulin and sulfonylureas because it’s very hard to offset carbohydrate with metformin, Actos® or Avandia®; whereas sulfonylureas, are almost as potent as insulin but they work by boosting your insulin levels. If you can make insulin and you get a sulfonylurea, you’ll have very high serum insulin levels.
Dr. Richard K. Bernstein is the Author of Diabetes Solution, www.diabetes911.net