Skip to comments.Aggressive pursuit of low BP, cholesterol levels may not benefit diabetics
Posted on 07/06/2010 9:52:19 AM PDT by Pining_4_TX
A mathematical model suggests that aggressively pursuing low blood pressure and cholesterol levels may not benefit, and could even harm, some patients with diabetes, according to a report in the June 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Almost all treatment guidelines for patients with diabetes suggest aggressively treating high low-density lipoprotein (LDL or "bad" cholesterol) and blood pressure levels to reduce patients' risk of developing heart disease, according to background information in the article. "These recommendations, which are based on the average results of trials evaluating the relative benefits of intensive risk factor control, are not tailored to an individual's underlying cardiovascular disease risk," the authors write. "While this [risk stratification] approach is often advocated in patients without diabetes mellitus, there is an implicit assumption that all patients with diabetes mellitus are at equally high risk, requiring all patients to be treated aggressively."
(Excerpt) Read more at news-medical.net ...
Doctors have forgotten the dictum, “First, do no harm.” All these medications lead to unforeseen side effects. Once again, the perceived benefit may not be worth the real risk.
“Drugs to Treat Adult Onset, Type 2 Diabetes
Avandia is one of a newer class of drugs designed to lower the blood sugar of adults whose blood sugar is higher than is said to be good for them.
As we age, our own insulin is less effective in helping our blood sugar enter our cells to provide an energy source. Some of us have this tendency earlier than others, particularly if we have a big gut-to-butt ratio and/or we’re poor.
This higher blood sugar and its fellow-travelers (higher blood pressure, higher cholesterol, and lesser wealth) are associated with earlier death, but only if any or all are particularly severe.
For over 50 years medicine has recruited the pharmaceutical industry to smite each of these “risk factors” a mighty blow in order to spare us grief. Avandia is another attempt to tackle persistently elevated blood sugar.
It works. It lowers the blood sugar. Furthermore, the earlier generations of drugs designed to do this also lower the blood sugar. They work too.
However, no one feels better for a lower blood sugar. Some feel worse or get fatter depending on the drug. And no one feels worse for a high blood sugar, except for the rare patient with adult onset type 2 diabetes who can mobilize an extremely high blood sugar.
It’s like “high” blood pressure.
So Avandia does nothing for the quality of your life. Does it do something else — save your life, or postpone the horrid complications some patients can get with adult onset type 2 diabetes and its fellow travelers?
We don’t know for Avandia. However the precedents are daunting. Long-term experiments, randomized controlled trials, with earlier generations of drugs that lower blood sugar are not encouraging. One famous trial lasted over a decade.
There is no precedent for any of these drugs saving a life, a limb, an eye, kidney or anything else important. There is no demonstrable benefit except the lowering of blood sugar. Who cares?
I have practiced medicine for 40 years. I have never prescribed a pill to lower blood sugar. I still see no reason to do so. If I am disadvantaging my patients, it’s to a trivial degree at most. However, I know I am sparing them known and unknown hazards.
And I won’t let you measure my blood sugar or the measure of its persistent elevation, the hemoglobin A1c. I don’t care, and I won’t care till there is compelling science that something meaningful can be done if it is elevated.”
- Dr. Nortin Hadler, MD
Or we have over-indulged in sugar
and other HIGH carbohydrates and
become immune to our own Insulin.
The Number Needed to Treat is the number of people who need to take a medication (or other therapy) for one person to benefit. You want this number to be as low as possible.
The Number Needed to Harm is the number of people who need to take a medication (or other therapy) for one person to be harmed. You want this number to be as high as possible.
A Bloomberg Businessweek article in 2008 explained these these two concepts in detail, in very easy to understand language, especially as they apply to cholesterol lowering drugs like Lipitor. Here's the URL: http://www.businessweek.com/magazine/content/08_04/b4068052092994.htm
I heartily recommend that everyone read this article and discuss it with your doctor. If you're taking a cholesterol lowering medication, or any other medication, you may decide not to do so after learning these concepts.
I forgot that BP has other meanings than British Petroleum
Or we have over-indulged in sugar and other HIGH carbohydrates and become immune to our own Insulin.
The reason insulin is less effective is that our body has lost it's sensitivity to insulin or IOW's it's ability to control insulin. Studies are showing we can get that sensitivity and control back, but not when the body has high insulin levels, either by injection or 'over-indulging in sugar'.
Without this industrial government sponsored poison in our food health would generally be much higher.
Correct. HFCS chemically breaks down into glucose.
and suppresses the "Ahhhhh I'm full hormone"(Leptin).
This is why most of us look like New Jersey in pants!
Ha, ha, funny how that works! I had to abbreviate, because it was a long title. :-)
Thanks for the link to that article! And you might find this interesting:
The author’s books, Worried Sick and The Last Well Person are gems. He points out how flawed most studies are and that they frequently report results in terms of relative risk, a very misleading number.