A recently published study examined the effects of more intensive treatment that kept their blood sugar levels the same as those of non-diabetics.
Standard Treatment
Typical therapy for type 2 diabetics involves targeting a glycated hemoglobin level of 7%. However, healthy individuals maintain a level of less than 6%. Since diabetes is a leading cause of heart disease, The Action to Control Cardiovascular Risk in Diabetes Study Group performed a long term study to determine if aggressively treating type 2 diabetics and keeping their glycated hemoglobin levels lower than 6% would improve their heart health. Their surprising findings were published in the June 2008 edition of the New England Journal of Medicine.
Intensive Therapy
The study took 10,251 patients around age 60 and randomly assigned them to either a standard therapy group or the test group. The test group patients frequently had the types and dosages of their drugs and insulin changed, over twice as often as those in the standard therapy group, with the goal of achieving lower glycated hemoglobin levels.
Lower Levels Achieved
A year after the study began the test group's glycated hemoglobin levels had dropped to a median of 6.4%, while the standard group's levels remained at 7.5%. These levels were stably maintained for the three and a half year length of the study.
More Harm than Good
The expectation would be that keeping glucose levels closer to those seen in healthy individuals would help combat some of the heart risks associated with diabetes, but the study found the opposite to be the case. The members of the intensive therapy group had a 22% overall higher mortality rate compared to those on standard therapy, a rate described as one more death for every ninety-five people in the group. They also experienced more weight gain, fluid retention, and hypoglycemia.
Despite this, there is some evidence that the intensive therapy could offer long term benefits after an approximately 3 year period of increased risk. Also, a portion of the test group may have seen benefit without increased risk, but this study only looked at the overall statistics. Researchers hope that by continuing to follow the health of the intensive therapy patients who were switched back to standard methods of treatment following the study they can learn more about the observed increase in mortality and the disease in general.
References:
"Effects of Intensive Glucose Lowering in Type 2 Diabetes", The Action to Control Cardiovascular Risk in Diabetes Study Group, N. Engl. J. Med., Jun 2008; 358: 2545 - 2559.
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