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...findings were published online in the New England Journal of Medicine (NEJM). The results of two other related studies were also published online: one large trial also looked at the effect of reducing blood pressure in diabetes patients; another trial, involving 9,300 patients who had high blood sugar and were at high risk of developing diabetes, measured the benefit of drugs that blunt the sharp peaks and valleys in blood glucose levels that occur after eating. Neither study showed benefits of these treatments in reducing risk of heart disease...
Although each of these studies included several thousand diabetes patients, which bolsters the reliability of their results, it doesn't mean they are the final word on the tested treatments. In the blood-fats arm of the ACCORD study, for instance, about 40% of the volunteers had already had a previous heart event and the remainder had risk factors, other than diabetes, that put them at high risk for heart disease, notes Dr. Om Ganda, director of the lipid clinic at Joslin Diabetes Center in Boston. That means the trial was not truly a primary-prevention study designed to test...
...researchers had hoped that treated patients would lower their risk of heart events because they were given both statin drugs, which curb the liver's production of cholesterol, and a fibrate, which mops up harmful triglycerides in the blood and boosts levels of "good" cholesterol. But all of the volunteers either already suffered from heart disease, or had two or more major risk factors for heart problems - including cigarette smoking, family history and high cholesterol - in addition to diabetes. That may have pushed their diabetes too far along to allow them to see any benefit from the drugs. "This...
That's a pattern that many diabetes experts expect to emerge more robustly as researchers dig deeper into the data. It's possible, for instance, that younger, newly diagnosed patients with diabetes may actually benefit from aggressively lowering their blood pressure, cholesterol and blood sugar levels - a trend that may have been lost in the noise of the current studies, which included patients who were up to 79 years old. "I tend to be far more tuned in to getting normal targets in my younger patients," says Dr. Daniel Einhorn, medical director of the Scripps Whittier Diabetes Institute...
...primary lesson that clinicians can take away from the new findings is that the blind push to lower all risk factors such as blood pressure or cholesterol isn't necessarily healthy, says Dr. Christopher Saudek, director of the diabetes center at Johns Hopkins University. That may even mean resisting the commonsense urge to reduce these measures to recommended or normal range in diabetics patients. "To me, it's a matter of having reasonable and patient-oriented individual targets," he says, "rather than trying to push and push and push just to get lower and lower glucose or blood pressure...