Diabetes Self-Management Blog

I’m gonna get in trouble for this one. I got so outraged reading media reports on the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial that I may say some nasty and completely true things about the medical establishment.

I didn’t follow ACCORD when it started. I only started paying attention when the intensive blood sugar control arm was canceled. The more I found out about it, the angrier I got. I believe ACCORD is a great example of most of what is wrong with American medicine, and with the way our media covers it. I wrote about this in Chapter 4 of my book Diabetes: Sugar-coated Crisis. But this story is as bad as anything I cover in the book.

ACCORD is sponsored by the National Heart, Lung, and Blood Institute (NHLBI), a government agency. All subjects in the trial have Type 2 diabetes and at least one other major cardiovascular risk factor. The idea was to see if heart attacks could be prevented in these patients through intensive drug therapy.

ACCORD has three “arms.”

There were two “blood sugar groups”: One aimed for an HbA1c of 7%, while the other, “intensive” group aimed for an HbA1c of less than 6%, which is considered the normal range.

There are two “blood pressure treatment groups”: One group aims for a systolic blood pressure of less than140 mm Hg, while the “intensive” group aims for less than 120 mm Hg.

And there are two lipid groups; both groups received cholesterol-lowering drugs called statins. The intensive-care group also received a fibrate drug to help lower triglycerides and raise HDL (”good”) cholesterol levels.

How did they lower these numbers?
From the beginning, ACCORD was a drug trial. The study called for participants to receive diet and exercise counseling if they wanted it, but set no guidelines for the counseling. There was no self-management group. It was all, repeat all, about the drugs.

Which drugs to use was up to the participating doctors, but many participants got pioglitazone (brand name Actos), rosiglitazone (Avandia), metformin, insulin, and others, in addition to whatever they were already taking for their heart problems, blood pressure, etc. This many drugs almost guarantees interactions and side effects.

In February, NHLBI stopped the intensive blood sugar control arm because more of the participants in that group were dying than in the normal care group.

Then came the outrageous part: NHLBI and media dummies came out saying that the intensive group’s blood sugars had been too low.

Of the media’s coverage, blogger Regina Wilshire wrote:

“Everyone seems to be bending over backward to say the intensive drug therapy…had nothing to do with the higher incidence of death in the trial…that it is the lowering of blood sugars to normal ranges that was the problem, not the means utilized to do it.”

Drug madness
Dr. Irl Hirsch, a diabetes researcher at the University of Washington, said in The New York Times that the study’s results would be hard to explain to some patients who have spent years getting and keeping their blood sugar down. “It will be similar to what many women felt when they heard the news about estrogen,” Dr. Hirsch said. “Telling these patients to get their blood sugar up will be very difficult.”

What kind of madness is this? You throw scads of drugs at sick people, treating only their numbers, not their bodies and lives as a whole. Then, when they die, you say it couldn’t have been the drugs. It must be the numbers. And you tell people with diabetes to get their blood sugars up.

You better believe that if ACCORD had shown a 10% decrease in cardiac deaths from intensive blood glucose management with drugs, those drugs would have become standard therapy for every person with Type 2 in the country. Nobody in the media would have said, “It wasn’t the drugs.” The drug companies would have made billions. That was the goal of the trial.

People are more than their lab numbers. Self-management, in which people can take charge of their own lives, has much more potential than intensive drug therapy. Drugs are OK, but they should be used cautiously, as part of a self-management approach that focuses on stress reduction, physical activity, healthy eating, and social support.

ACCORD and Iraq
The whole thing reminds me of the U.S. occupation of Iraq. Both were at least partly motivated by profit potential—in ACCORD, it was the drug companies, in Iraq, the military contractors and Halliburton.

In both cases, the media repeated exactly what the leaders said, whether it had any relationship to truth or even made any sense. From WMD to “The surge is working” to “We do not torture,” few in the media have challenged administration lies. From “Diabetes is all about lowering HbA1c” to “Heart disease is all about lowering cholesterol,” nobody questions medical statements that may have little evidence behind them.

Take-home message: Don’t believe what you read or hear in media, or from government or drug company spokespeople. My apologies if I went too far. Let us know what you think.

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Comments
  1. David, you are so right! And the ADVANCE study review did not confirm any increase in mortality from intensive BG management. I can’t believe the comment by Irl Hirsch that people would be told to get their blood sugar numbers up! (Of course, it’s the New York Times, which seems to have lost its collective mind. They recently published an article on fibromyalgia that basically said it was a plot by pharmaceutical companies to increase drug sales, not a real condition at all.) The news media used to be independent sources of information - not any more! They are just part of the big profit-making machine.

    Posted by delebra |
  2. I was with you, David, and in total agreement, until you decided to cross over nto political analysis and comparison. To me this was totally unnecessary. Please stay with the medical issues and leave the plitics to the political forums.

    Posted by loraf |
  3. David, you get no argument from me. Kudos to you for speaking the truth!

    Posted by Beth |
  4. Unfortunately, the main stream media like television and newspapers in the USA have huge budgets solely to pay for lobbyist in Washington to make sure that the government isn’t for the people but for the companies. How long did it take the FDA to remove Vioxx when they already had evidence that it can cause severe problems? Even now, Monsanto is lobbying congress to make it illegal to label milk that uses their drugs. How is this even ethical?

    Posted by Bahamut |
  5. Bravo to David for sticking his neck out and questioning all the hype and exposing poorly conceived studies which pass as the latest in medical science that gets reported uncritically by the big business media in this country. I am grateful that you have the courage to mention the big elephant in the room, the Iraq war and its staggering costs. The money for that war will come at the expense of social services and what little health care we have left. Already, cuts are being made to the federal Head Start program which serves the most vulnerable children. States are being told they must shoulder most of the costs for the Medicaid program, which will mean less health care for poor people. The economy is circling the drain, which will mean more people losing their jobs and their employer sponsored health benefits. I could go on and on, but we need more people to speak up. A very worried and outraged public health nurse.

    Posted by lorraine s |
  6. I think you missed something in your analogy and that is doctors were trying in the study to find a way to treat a group of people who refuse to use diet, exercise (stress reduction) and medication (if the others don’t completely do the job). Too often the majority of the population doesn’t want to do much more than throw a pill at a problem and call it done. For physicians trying to help patients who don’t want to control the number of doughtnuts they eat and refuse to move their body after eating it. I’m not a doctor, a pharm. rep or anything like that, just somebody with diabetes trying to control my chronic condition the best I can. Yes the media did not do a good job, but the problem didn’t start there. Those of us who know better, I hope continue to do what we know is the best thing, irregardless of the media dropping the ball and not reporting the full measure of the problem. If your in trouble, I’m this hall with you. Your comments are valuable, please keep it up.

    Posted by cyndi ramsey |
  7. Amen. The legal drug culture in Greater(including Canada) America is remarquable. When HRT was very popular I asked my GP for some. He said it was wonderful for the female but toxic for the male. I said what is good for the goose should be good for the gander. Many years ago for depression I told my GP that if he had feathers and rattles and I believed in the mumbo jumbo that he would be much more effective than with his prescription pad. Now data seem to show that AD are not more effective than placebos. The more so if placebos cost $5.00 per pill as the “real” thing. Yes outrage is justified so would be storming the Bastille. America needs another revolution however bad for business they are.

    Posted by CalgaryDiabetic |
  8. This appears to be just another in a long line of “experiments” by the government and the medical professions regarding people’s health. I have come to believe that they really don’t know one way or the other for sure what should be right or wrong and we all end up paying in the end. Case in point: remember when they told us to eat more carbohydrates because it would give us more energy and “brain power”? What happened was a “comedy” of errors that culminated in the bulk of the population gaining too much weight. We should just stop listening and learn to eat a balance of fruits, vegetables, and protein and exercise as we should!!!! Get out from in front of the TV and computers and that includes our kids.

    Posted by vlsaladin |
  9. The only good thing about Canadian vs US politics is that our horse and pony show is much much shorter. I dont know about the US but Canada is not a democracy and probably never was. The only thing that keeps the flame of democracy flickering are competent and out-spoken writers. And it worries me that if they actually ever became effective they will be suppressed. Here in Canada cigarette advertising on TV is not allowed for symetrical reasons all drug ads should also be banned. In laissez-faire capitalism who will pay for ads promoting exercise and diet ?

    Posted by CalgaryDiabetic |
  10. I am active in the political process both professionally and personally. Politics impacts our lives as diabetes in very real and concrete ways. The debate surrounding this study will decide what diabetes hear when they see their doctors. When I read the NYT article, I was very dismayed. The more I pondered the problem, the more I felt pure craziness was involved. I applaud the author’s analysis and statements. Remember the refrain from Deep Throad, “follow the money.” It applies to diabetes as much as to bringing down a corrupt and criminal president. We must always be conscious of following the money. Otherwise, the implication is to pig out and eat sugar, sugar, sugar and bread, bread, bread.

    Posted by 75Janice |
  11. keep your left wing views on iraq to yourself.i expect medical infromation from this site,not brainwashed politcal opions.

    Posted by Ron Dell |
  12. Mr. Spero, thank you for your insights and opinions regarding the ACCORD Study.

    However, your toxic, biased, unfounded political views are offensive, and inappropriate for this forum.

    In fact, they are so inappropriate, that they cast strong doubts on your credibility regarding this, and perhaps other, topics!

    Posted by jim80903 |

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