29 July 2011

Another Bad Science Study - Type 2 Diabetes

When are researchers and doctors going to wake up and learn? Apparently never! Another study published in the British Medical Journal (BMJ) warns doctors about placing their Type 2 diabetes patients on intensive glucose lowering treatments. Again they say that most doctors do this believing the patient will have a reduced risk of heart complications.

This time the study was done in France. They did not name this study shamefully so that we had something to refer to like we did in previous studies. Plus no mention was given as to whether this meta study used much of the same data used in other studies - ACCORD and ADVANCE or even the study done by the German group IQWiG, the Foundation for Quality and Efficiency in Health Care. For all we know they could have used the same information.

Again the researchers arrive at the same conclusion that there was no compelling reason to use intensive glucose-lowering treatment, also known as glycemic lowering therapies as are commonly prescribed in order to reduce the diabetes type 2 patient's risk of having cardiovascular complications, as well as renal and/or visual problems.

The researchers found the following benefits were identified with intensive glucose lowering treatments - the risk of non-fatal heart attacks dropped by 15% and the risk of microalbuminuria fell by 10% (an indication of heart disease and kidney problems). However, the treatment was associated with a 100% increase in the risk of dangerously low blood glucose levels (severe hypoglycemia).

The the authors felt it necessary to say - "Intensive glucose lowering treatment of type 2 diabetes should be considered with caution and therapeutic escalation should be limited."

It is not surprising that researchers and doctors repeatedly analyze data looking for information that is not there. Like others have said, bad results are obtained when the incorrect premise is used. In other words, bad science because they were looking for the wrong answers. Like Alan said in his blog (here) and I repeated in my previous blog (here), no consideration was done for changing lifestyle habits of diet and exercise.

If people will not change their lifestyles and are put on intensive glucose-lowering therapies, there is no reason to expect anything other than the results obtained. I say that they should stop spending money on worthless analysis of things that we already know, and concentrate on ways to get the results needed to reduce cardiovascular events and the other complications diabetes can cause. This means looking at what lifestyle changes will accomplish this and how best to work with patients to obtain these results.

This needs to be a lengthy study as it does take time for people to get into an exercise routine that they can sustain and enjoy. Changes in eating habits also take time as people have developed bad habits over time and will have to be shown how to sustain good eating habits and get past the hunger pangs and into good dietary habits. Other lifestyle changes will also be necessary such as regular eating times and carbohydrate counting will become necessary.

Then once these are in full operation and patients are seeing results, then glucose-lowering therapies can be gradually introduced if needed to assist patients in achieving their goals and possible reduce or prevent the related diabetes complications. It should be possible to patients to do lifestyle changes to manage diabetes and lower the risks for complications – if done properly.

The press release of this study may be read here.

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