You have probably seen the headlines: “Diabetics’ Deaths Tied to Lower Blood Sugar” and “Deaths in ACCORD Study Raise Questions About Diabetes Treatment Risks.” These are designed to get your attention, but what does this news really mean for you?
The ACCORD study is a federally funded clinical study designed to figure out whether extremely tight blood glucose control reduces heart attacks and other cardiac problems in diabetics. ACCORD (which stands for Action to Control Cardiovascular Risk in Diabetes) involved type 2 diabetics at high risk for heart problems. The study compared diabetics using standard treatment, whose A1c was similar to that of the average diabetic (7 to 7.9 percent) with a group of diabetics engaged in an intensive treatment regime, designed to get their A1c down to levels that are not technically diabetic (6 percent or less).
Halfway through the study, researchers found that the intensive treatment group had slightly more fatal heart attacks than the standard treatment group. Interestingly, the intensive group also had fewer non-fatal heart attacks than the standard treatment group. In other words, the diabetics undergoing intensive treatment were slightly less likely to have a heart attack, but when they did have one, it was more likely to be fatal. In light of these results, researchers decided that the intensive treatment was simply too risky to continue. The study will continue with just the standard treatment group.
Some diabetics wondered if this study meant that a lowered A1c meant a greater risk of heart attack. Nothing could be further from the truth. The ACCORD study simply demonstrated that extremely intensive treatments—the kind of blood sugar control that almost never occurs in the real world, outside a laboratory—might pose a greater risk of heart attack than following the standard treatments and practices your doctor has already prescribed for you. In fact, this study shows that the safest thing you can do for your heart is to keep treating your diabetes—watch your diet, exercise, take your medicine, and monitor your blood sugar.
The ACCORD study’s preliminary findings should have no impact on blood sugar targets for most people with diabetes. Controlling blood sugar is still critical for prevention of diabetes complications. The American Diabetes Association recommends an A1c of less than 7 percent. However, if you are older, have had diabetes for many years, and have other cardiovascular risk factors, your doctor may set your target A1c a little higher.
Talk to your doctor about the blood sugar goal that is right for you.