Large-scale study
"However, it appeared that, if a heart attack did occur, it was more likely to be fatal," said Dr. William Friedewald, a professor of medicine at Columbia University and chairman of the study's steering committee. "In addition, the intensive treatment group had more unexpected sudden deaths, even without a clear heart attack."
Dr. Bruce Hamilton, chief of endocrinology at the Baltimore V.A., which enrolled 180 patients in the study, said the results caught him somewhat by surprise because death rates at his hospital were about equal between the two patient groups.
FOR THE RECORD - A Page 1 article in Thursday's editions of The Sun about unexpected results in a national diabetes study misspelled the name of Dr. Sherita H. Golden, an endocrinologist at the Johns Hopkins School of Medicine. Also, it should have included a more complete explanation of the index, called glycosylated hemoglobin, that is used to measure glucose control. Specifically, it is the percentage of red blood cells that have a sugar attached to them.
The Sun regrets the errors.
"We never picked up anything," he said, noting that it took a study with thousands of patients to reveal the danger.
Hamilton speculated that some patients might have had moments where their blood sugar dipped dangerously low, a condition called hypoglycemia. When this happens, the nervous system responds by quickening the pulse and constricting blood vessels. That, in turn, can trigger a heart attack or arrhythmia.
From the outset, ACCORD study volunteers were a high-risk population - they had Type 2 diabetes for an average of 10 years, above-average blood sugar levels, heart disease and other risk factors such as high blood pressure or high cholesterol. Some were obese or smokers.
Those in the intensive treatment group will remain part of the study - which also looks at lowering blood pressure and cholesterol. But their blood sugar goals will be relaxed for the remaining 18 months, officials said.
Heart disease, stroke
More than 20 million Americans have Type 2 diabetes, and an estimated 284,000 die from it each year. Heart disease and stroke account for about 65 percent of their deaths. Adults with Type 2 diabetes are two to four times more likely to have a heart attack or stroke, or to die from heart disease, than nondiabetics.
A large body of research has shown that lowering blood sugar levels can significantly lower the risk of some complications from diabetes, including eye, nerve and kidney disease. One study has shown that patients with a more recent onset of diabetes than those in the ACCORD study showed a trend toward fewer heart attacks when their blood sugar levels were reduced.
But this was the first major clinical trial to study whether lowering diabetics' blood sugar levels to those of healthy people reduces the risk of heart disease.
The answer in this case was no.
