The secondary findings of the ACCORD trial reported out today, and already the media is buzzing. Though the news was disappointing, the results are not nearly as bad as some of the media headlines are making it out to be. ABC News is reporting: ACCORD Study: Cholesterol, BP Control Does Little Good for Diabetics and MSNBC states that Intense treatment hopes for diabetics dashed. If I were a diabetic, I might think that controlling blood pressure and cholesterol was not important. However, this couldn't be further from the truth.
The same thing happened when the media first reported that the ACCORD study was stopped.
( See ACCORD and ADVANCE: Good News for Type 2 diabetes...really). This first part of the study was looking at whether or not intense lowering of blood sugar to normal (A1c less than 6%) prevented heart attacks and strokes more than the current standard of care (A1c less than 7%) which had not proven to reduce heart attacks or strokes. The study was stopped early because there were more heart attacks and deaths in the intense group. However, though the media headlines similarly questioned the role of blood sugar control back then, the good news was that the rate of heart attacks and strokes were much lower than expected. In other words, good sugar control in diabetics is likely important in preventing cardiovascular disease; however, intensely lowering blood sugar is probably not a good idea.
What was reported today at the American College of Cardiology meeting was the blood pressure and cholesterol arms of the study. The blood pressure arm similarly looked at getting the blood pressure to normal (120/80) compared to standard care. Again, both groups had fewer heart attacks and strokes than expected. Thus, blood pressure control is important, just not continuing to add medicines until the BP is normal. The cholesterol arm of the study looked at something different. All the patients were given statins, but half were randomized to fenofibrate, a different kind of cholesterol medicine that doesn't affect bad cholesterol too much (LDL), but does raise good cholesterol (HDL) and lowers fats (triglycerides). Unfortunately, there was no difference in heart attacks or strokes in either group. However, when you looked at diabetics with low HDL and high triglycerides, there was an improvement. In other words, unlike statins which should be given to every diabetic, fibrates should be used only in diabetics with low HDL and high triglycerides. Again, this reinforces the importance of cholesterol lowering in diabetics, despite what the headlines may read.
Bottom Line: If you are a diabetic, try and keep your A1c under 7%, and don't take any more medicines (especially insulin) to try to get the A1c any lower. Blood pressure and cholesterol control are also very important. Diabetics should keep the blood pressure under 130/80, but don't need to keep adding medications to get it perfect (under 120/80). All diabetics should take a statin medications (regardless of LDL number), and if your triglycerides are above 200 and HDL is below 35, add a fibrate to the statin.
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18 comments:
I have always thought clinical guidelines a good thing. Guidelines help me practice better medicine. I have never thought adherence to guidelines should be a measuring stick for physician performance.
Even before the ACCORD trials any physician would have been nervous about piling on medications to achieve these goals (HbA1c < 7%, SBP < 130) when the problems with polypharmacy and drug interactions in the elderly are well documented. Not as much is to be gained in the elderly either.
Did you notice there was a slightly higher rate of death in the tightly controlled group, 1.28% / yr vs 1.19 % / yr (I don't think significant).
As always, treat the patient, not the number and if necessary take your lumps on the quality grading.
It is very important to maintain blood sugar levels. High Blood sugar can be very dangerous and unhealthy. High blood sugar in medical terms is known as hyperglycemia. Having high blood sugar can cause many diseases of heart, kidney etc. There are many signs of high blood sugar such as excessive urination,
excessive thirst, weight loss, tiredness etc. Right exercise and diet helps in maintaining blood sugar levels.
I think diabetes teaches you a good amount of control.With diet,with every thing in life.Important to keep the [pressure and the sugar levels under control.
Thanks for this additional information...very relevant to my dieting and health-keeping!
Thanks for sharing the thoughts on this subject.It is true that many things are inter related and one thing leads to other.
It is essential to be under good check when you are a diabetic and it is true that most of it is really related to each other.Like keeping pressure in control is a major factor also.
I is necessary to keep the blood pressure and cholesterol levels of the body under control for every person specially the diabetic.It is easy with a good control over food and a balanced lifestyle with regular exercise.
Hey there! I thought I’d share this CME and performance improvement platform with anyone who is interested. The content at www.penncmebestpractice.org is focused on improving care of patients with chronic diseases and includes preventive care. PennCME has program topics in diabetes and COPD, with activities in hypertension and immunization coming during the rest of the year. Participation in all of these certified CME activities is free. Physicians can earn as many as 30-40 AMA PRA Category 1 CreditsTM in diabetes and COPD activities alone.
Hello name is Alfonso Vargas and I am a medicine student of Catholic University of Maule in Talca - Chile
I think that you blog is very interesting and usable and especially this POST in where shows that not all we read of the headlines is totally true. I think this blog is a great contribution to the people and others doctors and medicine students like me.
Particulary the topic of the diabetes and cardiovascular disease and his prevention call my attention a lot, and I thing is very complex and a lot of people is affected by problems of this type.
Congratulation by you blog , go ahead with it. I thank you effort and dedication to people. I imagine that you are a exelent doctor.
Goodbye and good luck in the future.
Really very nice posting for blood sugar,high blood pressure and cholesterol control still important for diabetics.
Healthy lifestyle is an important part of treating diabetes.Treatment for high blood pressure and high blood cholesterol often begins earlier in people who have diabetes than in those who don't.
Reaching and maintaining a healthy weight is important for everyone with diabetes. Weight control is extremely important in treating type 2 diabetes because extra body fat makes it difficult for people with type 2 diabetes to make and use their own insulin.
healthy lifestyle is an important part of treating diabetes and DHD. Some people who have diabetes can manage their blood pressure and blood cholesterol levels with lifestyle changes alone. You should regularly check your blood pressure, both in your doctor’s office and at home.
Diabetes is a condition where you have to be watchful on the body.the lifestyle and the diet are the two major things either not controlled can get the worst of the disease.
Thanks for such a informative knowledge and your bottom line of suggestion is really awesome to avoid taking much medicine and maintain the blood pressure and diabetes under control.
Keep posting some more suggestion.
The diabetes patients have to be careful on these points surely and to control these diet becomes a very regulative factor other than the treatment that would help the patients.
I agree with your comments here dr. My mum is diabetic and she does a good job on keeping her blood sugar, her blood pressure and cholesterol under control most of the time. It's important.
Quite useful piece of writing, thank you for this article.
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