"Obviously no one would have expected this result," said Dr. Steven Nissen, a cardiologist at the Cleveland Clinic who led the Avandia study. "It's a wake-up call, and it really does tell you drugs have complicated effects."
Nissen said the findings will have an immediate impact on his practice. Earlier this week, if a diabetic with heart disease had arrived in his office with a blood sugar level of 7.5 percent (compared with less than 6 percent in a normal person), "I would add another drug." he said.
Raising doubts
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.
"Today I have to wonder if that's the right thing to do," he said. Conversely, he would have patted himself on the back if a patient under of his showed up with blood sugar of 6.2 percent. Now, he said, he would wonder, "Am I hurting or helping?"
ACCORD researchers said the goal of those in the standard treatment group (including the former intensive therapy patients) is a blood sugar level between 7 and 8 percent. Their advice to others: Diabetics with increased risk for heart disease should not be encouraged to reduce levels further than that.
"I'm grateful to know what the glucose target should be," said Dr. Sheria Golden, an endocrinologist at the Johns Hopkins Hospital.
Too far down
Golden said she's always mindful that driving blood sugar too low can trigger a hypoglycemic episode. "I'll get the glucose down as far as I can without complicating the patient with a hypoglycemic risk," she said.
ACCORD researchers found it difficult to get volunteers' blood sugar levels down to those seen in healthy people - they reached only 6.4 percent instead of the under-6 target.
Doctors said counterintuitive results are one reason why clinical trials are conducted.
"Essentially, we do need evidence when something seems like a good idea ... to see whether it pans out in real life," said Dr. Mary M. Newman, an internist in Lutherville. "It sounds biologically plausible but that doesn't mean it works out that way."
stephanie.desmon@baltsun.com jonathan.bor@baltsun.com
