Antidote

Researchers at the National Institutes of Health released findings of the ACCORD study which appeared to show that driving blood sugar to low levels in diabetics leads to an increased rate of dying. Over 10,000 patients were studied, with 257 deaths in the intensive therapy group and 203 in the standard group.                                         

This study was quickly misinterpreted by many in the media as somehow signifying that diabetes drugs with the goal of lowering blood sugar are somehow unsafe. Add this to the negative press Avandia has received recently, and I can easily imagine my diabetic patients reaching for ice cream cones rather than essential medication capsules.

This tendency in the media to see some of our best Rx drug treatments as dangerous leads physicians and their patients to jump from overuse to disuse. This, in the case of diabetes, despite the fact that several studies have shown that reducing blood sugar in diabetics can significantly lower the risks of acquiring eye disease, kidney disease  and nerve disease. It would be a shame if misinterpretation and panic in the wake of the ACCORD study actually leads to more disease.

Don't get me wrong, the ACCORD study is valuable, as it appears to show that an overzealous treatment plan intended to bring a diabetics' blood sugar down to the level of a non-diabetic may carry with it intrinsic medical risks. But this observation is not really surprising when you consider that we've known for a long time that very low blood sugars are riskier than high blood sugars. It is not surprising that patients who had their blood sugars aggressively lowered in the study were more likely to die of heart attacks than those whose sugars were moderately lowered.               

The take home message should be that we can't always have the same treatment goals in ill folks as we have in healthy ones. I also wish for once that the media could learn to tell the difference between a study's conclusions and the hype that can be drawn from it.

Marc Siegel, MD, is an internist and associate professor of medicine at New York University and the author of False Alarm: The Truth About the Epidemic of Fear

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