Did any of you catch this excellent article in the New York Times last week: Diabetes Case Shows Pitfalls of Treatment Guidelines? I was surprised to see very little blog chatter on it. It's a fascinating summary of the recent controversy over national blood sugar guidelines, sparked primarily by the ACCORD study that scared everybody off tight glucose control last summer.
The article explains how the benchmark for aggressive control of blood sugar was abruptly withdrawn, amidst fear that "lowering glucose too quickly or too much in some patients could harm or even kill them." I've published quite a bit about experts' counter-opinions here, namely that too-tight control is certainly ill-advised for some patients, who are very high risk for heart disease, and taking a host of other meds, etc. It's just a damn shame that the media frenzy over this study shot out so many erroneous messages (see here).
The plot thickens:
Critics suggest that pharmaceutical companies influenced the low A1c guideline so they could sell more of their glucose-lowering drugs. It seems that the standards committee, the National Committee for Quality Assurance, indeed received about $3 million, or 10 percent of its revenue, last year from drug and medical device makers. Hmm.
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"The main problem is that many guidelines are based not on rigorous studies like clinical trials but on weaker types of medical evidence," the article notes. The implication is that trying to bring the average diabetic's A1c level down to that of a person without diabetes can be potentially dangerous, and hasn't been studied enough with the right populations and methodologies.
Now in place is "a more a more nuanced guideline that, among other things, exempts patients over 55 years old with heart or cardiovascular problems."
For my part, I have two takeaways here:
1) More oversight of Pharma's role? Due to the way our system is historically and financially organized, conflict of interest is an ongoing, deeply embedded issue in medical research here. Pharma companies' involvement is not going to disappear any time soon. So rather than even attempting to chase them out, I wonder if these standards organizations could also be responsible for setting up strict guidelines on study methodology, to protect against "drug bias" by sponsoring organizations?
2) Watch those messages! As a person with diabetes, who now is in contact with scores of Type 2 patients who know very little about how to stay healthy with this disease, this whole issue still makes me want to scream! Unfortunately, the mainstream media message heard across the country here was "tight blood glucose control is now proven to be 'bad for you.'" How do you explain to somebody with an A1c of 10 or higher that it's not only safe, but imperative to their health to lower their glucose levels ASAP?
We've got your "Good Evidence" right here...