American and Australian Glucose Control Studies Conflict

02/18/08 Treatment Options

By Corie Richter

For years the American Diabetes Association (ADA) and other diabetic experts have stressed tighter control of glucose levels to fend off consequences of the disease. Now, they’re not so sure.

First, an American study published early last week found that patients with lower blood glucose levels actually had higher death rates. Second, to add to the confusion, a similar study from Australia arrived at an opposite conclusion just days later. Patients participating in the Australian study did not show an increased risk of death when they also had low blood sugar reading.

The American ACCORD (Action to Control Cardiovascular Risk in Diabetes) study enrolled diabetics with cardiac and/or vascular disease in one of two programs. The first group maintained normal glucose levels and hemoglobin A1Cs of 6 percent or below. The second set of subjects followed standard protocol of normal blood glucose but the A1C objective was between 7 and 7.9 percent(non-diabetic A1Cs run about 5 percent). 

Patients were all given intensive diabetic education, glucose monitoring devices, and medication. The more aggressive group received increased medication to include multiple classes of drugs. The findings half-way through the study were enough to bring part of it to a halt. The more aggressively treated patients had a higher death rate than those in the standard treatment group.

The higher mortality confused the researchers. They have ruled out the medications (including Avandia which has been suspected by some of having adverse cardiac effects) and the various drug combinations utilized.

Paradoxically, the death rate among this group, though higher than that of the participants receiving standard treatment, was lower than that of the general diabetic population.

In the interim, the National Institutes of Health and ADA encourage patients to strive for an A1C of 7 percent, and to speak to their health care practitioners.