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There have been several interesting findings that have come out since the initial bad press about ACCORD. These findings have not gotten much press. One of those findings was that the excess deaths were not due to hypoglycemic events. Another findings described in this article was that rapid lowering of blood sugar control was not a factor. What we have not heard is a clear study that has looked at whether the oral medications used to treat the patients caused the excess deaths.

In either case, it is probably prudent to follow what we learned from this study. As an older, long-term out of control T2 diabetic, don't take crude insulin regimes (like mixtard) and stack of large amounts of risky medications (like Avandia) and expect good outcomes. In fact, don't become a long-term out of control diabetic, and you will do a lot better.
I've also done a recent blogpost on this:

http://wildlyfluctuating.blogspot.com/2010/05/accord-again.html
Gretchen, that is great coverage of the ACCORD study. I had one doctor recommend that I increase my HbA1c above 7% based on the initial halting of the study. And my endo (who should know better) further told me that he was resisting prescribing insulin because he felt the ACCORD study demonstrated that aggressive blood sugar control with insulin cause hypos and excess deaths.

Thank you for your efforts to be a sensible voice in the sea of utter nonsense.
Judith and bsc, I hope you can get copies of the Diabetes Care article to take to your doctor so you can get more strips and get insulin. It's a crime when a doctor refuses to prescribe insulin. Motivated patients should be supported!
Thanks for the support. I consider myself widely read and I have insititutional access to many sources, unfortunately, as you are probably aware, Diabetes Care does not allow free access to its most recent articles. I wish the ADA would support patients by providing free access as other journals have done, but what can I say, the ADA has its priorities.

When I disagreed with my endo on the ACCORD I have to give him credit for at least asking me to support my claim. In response, I emailed him the following:

Endochrine Today "ACCORD: Intensive glucose control not to blame for excess mortality", June 10, 2009 on the ADA 69th Scientific session

“HbA1c was associated with hypoglycemia but not in the relationship we expected,” said Denise Bonds, MD, MPH, project officer for ACCORD at the National Heart, Lung and Blood Institute, National Institutes of Health.

Severe hypoglycemia was associated with higher risk for death in both treatment groups but a lower risk in the intensive group vs. standard group (HR=1.28 vs. HR=2.87). Further, risk for hypoglycemia was lower in the intensive control group who achieved the target goal faster compared with the standard group (HR=0.86 vs. HR=0.72). Importantly, hypoglycemia did not account for overall mortality findings.

“Hypoglycemia was felt to play no role in most deaths,” Bonds said. Few deaths occurred within 90 days of a documented episode of severe hypoglycemia.


He did not respond to the email and has not provided further claims, but he is still "resistant." While I think you are right that everyone applauds a motivated patient, many doctors have difficulty with well informed and decisive diabetics and even more so deferring to the patient as the primary authority leading the treatment of the condition. And if anything, I have to admit, I can be a difficult patient.

Thanks Aeon for bringing this old post back to the surface. I would love to see a better designed study of tight control in T2. One that emphasizes a moderate low carb diet and exercise without the harmful drugs such as Avandia and the likes.

I would like to see a study where insulin is used more frequently when the drugs without cardio risk do not do the job. Then maybe we will see progress in the treatment of T2. It's my opinion that the 2 and 3 drug combos frequently seen in T2 treatment is a dangerous approach that frequently does not work.

It's no wonder the ACCORD study did more damage than good in the hard to control group considering the cocktail of drugs given to them. Recent interpretations of ACCORD just goes to prove this point.

Gary

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