In this randomized study, 10,251 patients (mean age, 62.2 years) with a median glycated hemoglobin level of 8.1% were assigned to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level from 7.0 to 7.9%). Of these patients, 38% were women, and 35% had had a previous cardiovascular event. The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The finding of higher mortality in the intensive-therapy group led to a discontinuation of intensive therapy after a mean of 3.5 years of follow-up.
At 1 year, stable median glycated hemoglobin levels of 6.4% and 7.5% were achieved in the intensive-therapy group and the standard-therapy group, respectively. During follow-up, the primary outcome occurred in 352 patients in the intensive-therapy group, as compared with 371 in the standard-therapy group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P=0.16). At the same time, 257 patients in the intensive-therapy group died, as compared with 203 patients in the standard-therapy group (hazard ratio, 1.22; 95% CI, 1.01 to 1.46; P=0.04). Hypoglycemia requiring assistance and weight gain of more than 10 kg were more frequent in the intensive-therapy group (P<0.001).
Using drugs from that time. I highly doubt someone losing weight below their fat threshold for type 2 diabetes would increase their mortality (as long as it’s to a normal BMI), and results for newer drugs and trials is very likely different.
Dr Bernstein introduces the session, focusing on the distortion of scientific study results related to diabetes management.
The discussion centers around the Accord trial, which examined the relationship between blood sugar levels and cardiovascular risk in diabetes patients.
Overview of the Accord Trial
The Accord trial, formally known as Action to Control Cardiovascular Risk in Diabetes, was reported in the ADA journals in 2010.
The study concluded that efforts to lower blood sugar levels to an A1C of six or below increased mortality rates among participants.
Dr Bernstein mentions a conversation with one of the study’s authors, who revealed that the conclusions were predetermined despite the dissent of participating doctors.
The study’s findings suggested that lowering blood sugar did not benefit cardiac health, which was later echoed in a press release from the American Diabetes Association.
Critique of the Study’s Conclusions
Dr Bernstein highlights that the Accord study lasted only about three and a half years, which is insufficient for drawing long-term conclusions about cardiovascular disease prevention.
An alternative analysis published in the same journal indicated that lower average A1C levels were not associated with increased mortality, contradicting the ADA’s conclusions.
The analysis found that higher mortality rates were observed in patients with higher average A1C levels, suggesting that those with lower A1C levels had better survival rates.
Impact of Misinterpretation
Dr Bernstein explains that the erroneous conclusions from the Accord study led to widespread misconceptions among healthcare professionals regarding the dangers of low A1C levels.
This misinformation has resulted in many doctors believing that low A1C levels are harmful to heart health, which has influenced diabetes treatment protocols negatively.
The misinterpretation has also contributed to a reluctance to normalize blood sugar levels in diabetic patients, potentially harming their overall health outcomes.
Potential Benefits of Erroneous Conclusions
Dr Bernstein discusses possible motivations behind the propagation of these erroneous conclusions, suggesting that pharmaceutical companies may benefit from increased sales of medications for diabetes-related complications.
He notes that by promoting the idea that higher blood sugars contribute to heart disease, companies can justify the marketing of various drugs aimed at treating such complications.
Another group that may benefit includes healthcare practitioners who advocate for high carbohydrate diets and insulin treatments, as they may avoid liability related to hypoglycemic incidents.
Conclusion and Call to Action
Dr Bernstein concludes the session by emphasizing the importance of accurate blood sugar control in diabetes management and the dangers of misinterpreting scientific studies.
He encourages viewers to explore his book, “Diabetes Solution,” and participate in his monthly seminars for further education on diabetes management.
Dr Bernstein invites audience members to engage with the diabetes forum for community support and to ask questions during his teleseminars.
Yes, this study was very well publicized at the time and caused a lot of discussion - I remember it well . A big issue is as A_User observed, the particular medications used to lower blood sugar. Nonetheless the Bernstein video is unfortunate in the respect of engaging is unnecessary conspiratorial theorizing. A dispassionate examination of all the methodology of the study is called for, rather than questioning the motivation and ethics of the study leaders.
. A big issue is as A_User observed, the particular medications used to lower blood sugar. Nonetheless the Bernstein video is unfortunate in the respect of engaging is unnecessary conspiratorial theorizing. A dispassionate examination of all the methodology of the study is called for, rather than questioning the motivation and ethics of the study leaders.