A Tale of Two Diabetes Studies

Many people who follow low-carb diets do it to achieve greater blood glucose control. Therefore, it was disconcerting when ten days ago the news was full of a large study of diabetics ("ACCORD") which was halted when it was found that patients in the more aggressive treatment group, who had lower blood glucose as a result, had more deaths than the patients with higher levels of blood glucose.

Note that none of the researchers said that the lower blood sugar itself caused the result -- it could have been the more agressive drug therapy that these patients were on, or some other factor. Nor are they clear on what caused the extra deaths at this point. And no one was recommending that treatment programs or goals be changed based on this preliminary data. In fact, the American Diabetes Association recommended not changing anything. However, this did not stop the media from producing headlines such as, "Diabetes Study Shows Lowering Blood Sugar Increases Death Risk" and "Diabetes Study Upends Another Long-held Belief". In my opinion, these kinds of headlines are blatantly irresponsible, and I also wonder what is to be gained by blasting this story everywhere before we have a decent analysis of what was going on in the study.

The findings in the ACCCORD study prompted researchers in Austalia to peek into a similar study in progress there called ADVANCE. Were the results the same? No, not at all! Their data did not show increased deaths in the lower blood glucose group, despite the fact that twice as much data has been collected so far in the ADVANCE study. So the interim advice is to wait until the results of both studies, plus one additional similar one, are available.

What are we to think?

First of all, it's important to understand how science proceeds. Understanding of an issue is built one brick at a time, and often the pieces of information conflict and must be investigated further. It takes time for a complete picture to emerge.

Secondly, we absolutely KNOW that high blood sugar is related to the complications of diabetes. The eyes, the kidneys, the heart, the nerves -- almost every system in the body is adversely affected when blood glucose is allowed to go too high for too long.

Third, because this is not a published study, we don't have a clear look at exactly what went on. We do know that the people in the group striving for normal blood sugar were given high amounts of medication, including insulin, sometimes many times per day. We also have indications that they were eating the standard ADA-recommended diet, in which over half of the calories can come from carbohydrate. This combination can cause problems with blood glucose going up and down - meds can cause it to become too low, which causes people to need to eat carbs, then sugar gets too high, so more meds, etc. This is one reason why Dr. Richard Bernstein talks about the "Law of Small Numbers" - eat few carbs, produce less blood sugar variation, need less medication, etc. Larger amounts of carbohydrate and/or medication can more easily lead to "overshooting" in one direction or the other. Dr. Michael Eades alludes to this in his interesting speculations about the ACCORD study.

Fourth, for those on low-carb diets to control blood glucose, there is absolutely no evidence that using diet, exercise, and other lifestyle changes to lower blood glucose is anything but beneficial.

For some reason, there seems to be an escalation in recent years of medical reporting which is less-than thorough, and sometimes even misleading. So the next time you see a scary medical headline in the news, take a deep breath, and get some facts.

Photo © Eugene Bochkarev

Related Resources:

• What is Diabetes, and How Does It Develop?
  
  
• More Diabetes and Prediabetes Information
  
  
• How to Interpret Medical Stories in the News from Trisha Torrey, About.com's Guide to Patient Empowerment