NCPA - National Center for Policy Analysis


February 7, 2008

Using drugs to lower blood sugar more aggressively appears to increase the risk of death for diabetics who are already at unusually high risk for heart attack and stroke, say researchers.  

One arm of a federally funded study called Accord, is being halted early because patients receiving the extra-aggressive treatment were more likely to die than those receiving standard treatment, according to officials at the National Heart, Lung and Blood Institute.

Both groups had lower death rates than those in other studies.  But the extra aggressive treatment group had three more deaths per 1,000 patients per year than the standard treatment group, which prompted a safety monitoring committee to recommend halting that arm of the study.

  • The aggressive treatment group had a target blood sugar goal, measured by hemoglobin A1c, of less than 6 percent, which is similar to levels in adults without diabetes.
  • The standard treatment group had a target of 7 to 7.9 percent, which is similar to what is achieved, on average, by U.S. diabetics, says the NHLBI.
  • Guidelines released last year by the American College of Physicians said that a level of less than 7 percent is a "reasonable goal for many but not all patients."
  • American Diabetes Association guidelines from 2006 say less the A1c goal "for patients in general" is less than 7 percent, with the possibility of going lower for some patients.

Doctors treating patients in the study could use all of the major classes of diabetes drugs. In an interesting side note, NHLBI officials say GlaxoSmithKline's Avandia, which may increase the risk of heart attacks, was not associated with increased deaths in this study.

The study was limited to patients with type 2 diabetes. And the findings aren't expected to change therapy for most people with the disease.

Source: Jacob Goldstein, "Aggressive Diabetes Treatment Raises Death Risk for Some," Wall Street Journal, February 6, 2008.

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