From The Book of Blood Sugar 101 what They do not tell you about Diabetes by Jenny Ruhl
Two large studies
published within weeks of each other in early 2008 came to dramatically
different results on this question.
Sadly, because most doctors have time only to read the headlines and
don’t look into the details of these studies, many patients are being given the
toxic—and inaccurate—advice to keep their A1cs high to protect their hearts.
The first published study, called ACCORD, found that a population of people
with diabetes and heart disease who had followed an aggressive program of
lowering blood sugar had slightly more heart attack deaths than a control group
who pursued laxer blood sugar control even though the group who followed the
aggressive program attained an average A1c of 6.4%. However, the second study,
ADVANCE, which had enrolled twice as many subjects as ACCORD and lasted longer,
found no increase in deaths in the group of participants treated more
aggressively. They too attained an average A1c of 6.4%.
Subsequent analyses of
the ACCORD data revealed what it was that was to blame for the very slight
increase in mortality in the group shooting for lowered A1cs: high blood
sugars.
Though people in the ACCORD “tight control” group were shooting for
lower A1cs, many in that group did not achieve them, and it was those people
who appear to have had a higher risk of death. As one analysis concluded,
“Higher average A1C was associated with greater risk of death.” [emphasis mine]
A principle investigator for one site involved in the ACCORD study is also
quoted as saying.
A1c below 7% alone does not appear to explain
the excess deaths in the ACCORD trial and is not necessarily a predictor of
mortality risk. ... Further, the rate of one-year change in A1c showed that a
greater decline in A1c was associated with a lower risk of death.
The Heart-Toxic
Drugs Avandia and Actos Were Also to Blame
There are many different
ways to lower A1c—but in both these studies patients eating high
carbohydrate/low fat diets controlled their blood sugars entirely through the
use of antidiabetic drugs. Which drugs were used varied from study to study.
Supplementary material published with the ADVANCE study, the one which found no
increase in deaths in the group that lowered A1c, shows that ADVANCE relied
mostly on the sulfonylurea drug, gliclazide, which as we will see later, in
Chapter Eight, is a safe drug that doesn’t harm the heart. Patients in ADVANCE who did not get to goal
with gliclazide were put on metformin and several other drugs including basal
and fast acting insulin. But only 32 (.6%) of the 5,571 people in the intensive
control arm of ADVANCE were taking Avandia or Actos.
The case was very
different in ACCORD. 4,702 of the 5,128 people in the intensive treatment arm
of ACCORD were taking either Avandia or Actos—and 91.7% of those were taking
Avandia. As you’ll read in Chapter Eight, it is now known that Avandia causes
heart attacks. Both Avandia and Actos can also cause heart failure. Another bit
of information that got lost in the reporting about ACCORD is that the full
text of the research paper makes it clear that the increased risk of excess
death in the tight control group was largely found in people who had already
experienced heart attacks before the study started—those who would have been
most prone to the heart failure Actos and Avandia promote. Among those who had
not had heart attacks before the study, the risk of heart disease dropped with
tight control.
If your doctor warns you that lowering your A1c below 6.5%
raises the risk of heart attack, share these findings with him—the citations
can be found in the Reference section of this book. And remind your doctor,
too, that both ADVANCE and ACCORD found that lowering A1c lowered the incidence
of the classic diabetic complications—neuropathy, retinopathy, and kidney
disease.
This is exactly copied from Jenny Ruhl book of Blood sugar 101
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