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Diabetes Study Ends Early With a Surprising Result.

Previously posted at Times website.

Comment by Dr. Martha Grout MD, MD (H), Arizona Center for Advanced Medicine, to the NY Times about this article:

No effort was made to measure inflammation, as far as I can see. And all the patients were on intensive lipid-lowering drugs (without mention of CoQ-10 replacement therapy). So the results were in a sense predictable. If we still have a high inflammatory state (eating pro-inflammatory foods, requiring detoxification of chemicals and pharmaceutical drugs) AND we take a drug which completely stops the synthesis of CoQ-10 (required for the mitochondria to detoxify the body and produce energy for its sustenance) AND we do not give the body what it needs in order to detoxify the drugs that we are giving it – is it really surprising that mortality would not be reduced, and might even be higher?

I would be very interested in seeing a study which compared standard diabetes management with a regimen consisting of intensive anti-inflammatory control through measures like nutritional support, dietary glycemic index control, mental/emotional stress relief measures. We have patients who get off their glucose-lowering medications completely, through these measures alone.

- Martha M Grout, MD, MD(H) Scottsdale, AZ

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Diabetes Study Ends Early With a Surprising Result.

A large federal study of whether diet and weight loss can prevent heart attacks and strokes in overweight and obese people with Type 2 diabetes has ended two years ahead of schedule because the intensive program did not help.

“I was surprised,” said Rena Wing, the study’s chairwoman and a professor of psychiatry and human behavior at BrownUniversity’s medical school.

Like many, she had assumed diet and exercise would help, in part because short-term studies had found that those strategies lowered blood sugar levels, blood pressure and cholesterol levels.

But, Dr. Wing added, “You do a study because you don’t know the answer.”

Still, medical experts said there were many benefits to diet and exercise even if they did not reduce cardiovascular disease in people with diabetes.

About 25 million Americans have Type 2 diabetes. Many are overweight or obese. On average, the disease increases heart disease risk by 2 to 2 ½ times, said Dr. Ronald Kahn, chief academic officer at the Joslin Diabetes Center in Boston.

It seemed logical that diet and exercise would help reduce that risk. An earlier federal study found that an intense diet and exercise program helped prevent overweight or obese people with elevated blood sugar levels from crossing the line into diabetes. The hope was that a similar program could also protect people from heart disease.

The study randomly assigned 5,145 overweight or obese people with Type 2 diabetes to either a rigorous diet and exercise regimen or to sessions in which they got general health information. The diet involved 1,200 to 1,500 calories a day for those weighing less than 250 pounds and 1,500 to 1,800 calories a day for those weighing more. The exercise program was at least 175 minutes a week of moderate exercise.

But 11 years after the study began, researchers concluded it was futile to continue — the two groups had nearly identical rates of heart attacks, strokes and cardiovascular deaths.

The investigators are analyzing their data and will be publishing them in research papers.

But the outcome is clear, said Dr. David Nathan, a principal investigator and director of the Diabetes Center at Massachusetts General Hospital. “We have to have an adult conversation about this,” he said. “This was a negative result.”

The study participants assigned to the intensive exercise and diet program did lose about 5 percent of their weight and managed to keep it off during the study. That was enough to reduce cardiovascular risk factors.

“We showed that meaningful weight loss — let’s put ‘meaningful’ in quotes — could be established and maintained,” Dr. Nathan said. “To me that means we did a good experiment. We had a fair test of this hypothesis.”

Some, like Dr. John Buse, director of the University of North   Carolina’s diabetes center, said the study confirmed what they would have expected. Dr. Buse, a former president of the American Diabetes Association, said treatments including smoking cessation, statins to reduce cholesterol and blood pressure medications are so powerful that they could swamp the modest effects of weight loss or exercise on cardiovascular risk.

Other medical experts said they were waiting for release of the detailed data collected by the researchers before interpreting the study.

“It is hard to tell anything without the details of the study,” said Dr. Irl Hirsch, medical director of the Diabetes Care Center at the University of Washington.

Dr. Nathan, though, said the results meant that people with diabetes might have a choice. The group assigned to diet and exercise ended up with about the same levels of cholesterol, blood pressure and blood sugar as those in the control group, but the dieters used fewer medications.

“That may be the choice we are highlighting,” Dr. Nathan said. “You can take more medications — and more, I should say, expensive medications — or you can choose a lifestyle intervention and use fewer drugs and come to the same cardiovascular disease risk.”

He is not going to say which is better, Dr. Nathan added. That is up to the individual. But, he said, “those are real choices.”

View the entire article, click here >> http://goo.gl/gBZGZ .

What If Dieting Merely Lets Diabetics Take Fewer Medicines?

New York Times reporter Gina Kolata does a great job sifting through the wreckage of a federally funded study that failed to show a benefit to dieting and sustained weight loss for people with adult-onset diabetes. At the end, from Harvard diabetes specialist David Nathan, is this:

Dr. Nathan, though, said the results meant that people with diabetes might have a choice. The group assigned to diet and exercise ended up with about the same levels of cholesterol, blood pressure and blood sugar as those in the control group, but the dieters used fewer medications.

“That may be the choice we are highlighting,” Dr. Nathan said. “You can take more medications — and more, I should say, expensive medications — or you can choose a lifestyle intervention and use fewer drugs and come to the same cardiovascular disease risk.”

That’s a pretty shocking idea — that makes diet and exercise merely a way to reduce, but not eliminate, the need for drug treatment. The reality of many chronic diseases, like heart disease and diabetes, may well be that they are unlikely to be treated by diet alone.

View the entire article, click here >> http://goo.gl/cnxo0 .

Tight Blood Sugar Control May Put Some Diabetics at Risk

Death risk higher in those with type 2 and heart disease striving for ‘normal’ glucose levels: study

Intensive blood sugar control doesn’t benefit people with both type 2 diabetes and heart disease — and it may harm them, researchers say.

Trying to maintain the blood sugar levels typical of people without diabetes can increase the risk of death for people with type 2 diabetes and heart disease by 19 percent, according to the latest analysis from the long-running ACCORD study.

“This study reports that at least over the five-year period of time, although there continued to be a reduction in the rate of [heart attack], a significant increase in mortality still exists,” said the study’s lead author, Dr. Hertzel C. Gerstein, the Population Research Health Institute Chair in Diabetes Research at McMaster University in Hamilton, Canada.

ACCORD stands for Action to Control Cardiovascular Risk in Diabetes. This study was designed to assess whether intensive blood sugar interventions to bring A1C levels to under 6 percent would benefit people with type 2 diabetes and heart disease. A1C is a long-term measure of blood sugar control, and the A1C level provides about two to three months of average blood sugar levels. A level of under 6 percent, which is considered normal or non-diabetic, can be difficult for someone with diabetes to achieve.

The people recruited for the ACCORD study were between 40 and 79 years old, and their A1C levels were above 7.5 percent at the start of the study. Study volunteers were randomly assigned to either intensive blood sugar control or to a standard diabetes program striving for levels of 7 percent to 7.9 percent.

The study began in 2001 and was halted in February 2008 when researchers realized that people in the intensive treatment group had an increased risk of dying. By then, the intensive treatment group had received 3.7 years of treatment aimed at lowering their A1C levels to below 6 percent. Achieving such tight blood sugar control often required numerous interventions, such as lifestyle changes along with medication, multiple medications or insulin therapy.

The analysis includes five years of data. For the intensive group, that meant an average of 3.7 years of intense treatment, followed by 1.3 years of standard therapy.

At the time the study was stopped, the intensive therapy group experienced a 21 percent reduction in the risk of heart attacks, but a 21 percent increase in the risk of all-cause mortality.

After five years, the researchers found that the risk of heart attacks was still decreased by 18 percent, but the increased risk of all-cause mortality also persisted. People in the intensive therapy group had a 19 percent increased risk of dying of any cause, according to the study, published March 3 in the New England Journal of Medicine.

Gerstein said many researchers have tried to tease out why intensive blood sugar control might up the risk of death, and so far, no one has succeeded. Causes that have been ruled out include low blood sugar levels (hypoglycemia) and the rapid change in blood sugar levels.

“This study really reminds us that we always need to be prudent. Even if we think something is the right thing to do, sometimes we may have findings that are unexpected,” said Gerstein.

“This study confirms the results of the ACCORD trial over the full duration of the study,” said Dr. Vivian Fonseca, president-elect of medicine and science for the American Diabetes Association.

“Overall, this means that the recommendations of the American Diabetes Association hold true. In general, people with diabetes should aim for an A1C goal of less than 7 percent, but clearly individualization is important. One size does not fit all,” said Fonseca.

And, the findings suggest that people with type 2 diabetes and heart disease shouldn’t attempt to achieve an A1C below 6 percent, the study authors said.

Gerstein and Fonseca noted that the ACCORD findings should not be generalized for everyone with diabetes. People with type 1 diabetes and those with type 2 diabetes and no history of heart disease were not included in this study.

“There is no reason to change current guidelines because of this study, and this study certainly doesn’t support ignoring glucose control. We saw benefits in eye disease and many other outcomes with good control,” said Gerstein.

View the entire article, click here >> http://goo.gl/he0IT .

Long-term effects of intensive glucose lowering on cardiovascular outcomes.

Abstract

BACKGROUND:

Intensive glucose lowering has previously been shown to increase mortality among persons with advanced type 2 diabetes and a high risk of cardiovascular disease. This report describes the 5-year outcomes of a mean of 3.7 years of intensive glucose lowering on mortality and key cardiovascular events.

METHODS:

We randomly assigned participants with type 2 diabetes and cardiovascular disease or additional cardiovascular risk factors to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level of 7 to 7.9%). After termination of the intensive therapy, due to higher mortality in the intensive-therapy group, the target glycated hemoglobin level was 7 to 7.9% for all participants, who were followed until the planned end of the trial.

RESULTS:

Before the intensive therapy was terminated, the intensive-therapy group did not differ significantly from the standard-therapy group in the rate of the primary outcome (a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes) (P=0.13) but had more deaths from any cause (primarily cardiovascular) (hazard ratio, 1.21; 95% confidence interval [CI], 1.02 to 1.44) and fewer nonfatal myocardial infarctions (hazard ratio, 0.79; 95% CI, 0.66 to 0.95). These trends persisted during the entire follow-up period (hazard ratio for death, 1.19; 95% CI, 1.03 to 1.38; and hazard ratio for nonfatal myocardial infarction, 0.82; 95% CI, 0.70 to 0.96). After the intensive intervention was terminated, the median glycated hemoglobin level in the intensive-therapy group rose from 6.4% to 7.2%, and the use of glucose-lowering medications and rates of severe hypoglycemia and other adverse events were similar in the two groups.

CONCLUSIONS:

As compared with standard therapy, the use of intensive therapy for 3.7 years to target a glycated hemoglobin level below 6% reduced 5-year nonfatal myocardial infarctions but increased 5-year mortality. Such a strategy cannot be recommended for high-risk patients with advanced type 2 diabetes. (Funded by the National Heart, Lung and Blood Institute; ClinicalTrials.gov number, NCT00000620.).

View the entire article, click here >> http://goo.gl/0StkZ .

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April 19, 2013 | Categories: Articles, Weight Loss, Diabetes | Tags: acupuncture, allergy testing, bio-identical hormones, brain training, Arizona, Advanced Medicine, cancer (IPT), weight loss, ADHD, allergies, anxiety, Holistic medicine, conventional medicine, holistic center, medical doctor, doctor, holistic, Chinese Medicine, treatment, Scottsdale, Az, cancer cure, Raintree, north Scottsdale, over 40’s tune-up, chronic illness, integrative oncology, integrative cancer care, alternative cancer care, alternative, alternative diabetes care, diabetes, functional medicine, fibromyalgia, tick bone disease, lyme disease, co-infection, infection, irritable bowel, asthma, allergy, detox, detoxification, chelation, vitamin c, vitamin c-4, vitamin c IV, multiple chemical sensitivity, natural homeopathic, Dr Martha Grout, Dr Jonathan Murphy, Deborah Murphy, MD, MD(H), PA-C, clinic, patient, Phoenix, allergens, children, adults, environmental medicine, healing, natural, cancer DNA, gilbert, chandler, tempe, mesa, biltmore, paradise valley, old town, tucson, peoria, glendale, camelback, internal medicine doctor, breast cancer, organic, AdvancedMedAz, nutrition, Naturopathic Physician, free consultation, Hypnosis, women’s wellness, genetics, allergy forecast, homeopathy, bell rd, dc ranch, mcdowell mountain ranch, grayhawk, desert ridge, troon, troon north, cancer center, IPT, mammogram, cholesterol, crossroads clinic, mayo clinic, photron genius, Chiren, biontology, energy medicine, biophotonic medicine, Insulin Potential Therapy for Cancer, stress, an alphabet of good health in a sick world, ptsd, advancedwomenaz, top doc, Arizona Center for Advanced Medicine, Scottsdale allergy clinic, arizonaadvancedmedicine.com, gluten free, gmo food labeling, phoenix magazine top doctor, Diabetes Study Ends Early With a Surprising Result., 4 day allergy asthma forecast for phoenix az, desert mountain, cave creek, flu, Naturopathic Medicine, Homeopathic Medicine, Allopathic Medicine, Homeopathic Physician | Leave A Comment »