Studies Differ on Benefits of Aggressive Blood Sugar Control

"In people with type 2 diabetes who are at high risk for cardiovascular disease, a therapeutic strategy that targets a blood sugar level below current recommendations increases mortality," ACCORD researcher Dr. Hertzel C. Gerstein, a professor in the Department of Medicine at McMaster University in Hamilton, Ontario, Canada, said during the teleconference.

"The reasons that people died was varied and there was no one reason that people died, and there was no clear difference in the actual cause of death in the intensive or standard group," Gerstein said. "Many analyses have been done to try to see if a reason could be found to explain why there was this mortality finding. At this point in time, none of these analyses have identified any one reason."

In the study, 10,251 patients with type 2 diabetes received intensive blood sugar control or standard treatment. During the trial, there was a 35 percent higher rate of death from cardiovascular events among patients in the intensive treatment group. However, those in the intensive care group also had a 24 percent lower risk of having a nonfatal heart attack. There was no difference between the groups in the risk for nonfatal stroke or heart failure, the researchers found.

Despite the findings of the ACCORD trial, one diabetes expert doesn't think they apply to most people with type 2 diabetes.

"Early and aggressive blood glucose control remains the optimum treatment approach for people with type 2 diabetes," said Dr. James A. Underberg, a clinical assistant professor of medicine at New York University Medical School.

Underberg said the results of the trial reflected the patient population in the study -- people with heart problems -- and not the dangers of aggressively lowering blood sugar.

"Data showing that high-risk patients are at greater risk for heart disease are not surprising, and should be considered a non-event for the average patient," Underberg said. "It's important that we don't lose sight of the benefits of lowering blood sugar, including fewer long-term microvascular complications."

"As I've always told my patients with type 2 diabetes, it's important to achieve and maintain your blood sugar goals," he said. "ACCORD hasn't changed any of that. The trial was conducted in a select patient population, which is just not reflective of the majority of the millions of Americans with type 2 diabetes."

More information

To learn more about type 2 diabetes, visit the American Diabetes Association.

SOURCES: June 6, 2008, teleconference with Anushka Patel, M.D., director, Cardiovascular Division, The George Institute for International Health, and associate professor, Faculty of Medicine, University of Sydney, Australia; Hertzel C. Gerstein M.D., M.Sc., professor, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; June 6, 2008, presentations, American Diabetes Association annual meeting, San Francisco; June 12, 2008,New England Journal of Medicine; Spyros Mezitis, M.D., endocrinologist, Lenox Hill Hospital, New York City; James A. Underberg, M.D., clinical assistant professor, medicine, New York University Medical School, New York City