James K. Rone, MD, FACP, FACE

More on Diabetes Progress

June 5, 2014

Tags: Diabetes

More on Diabetes Progress

This is a follow up to my 4/27/14 posting “Diabetes Progress—a Tale of Two Studies,” in which I mulled the significance of recently published data on improvements on blood-sugar control and complication rates in diabetes over the last quarter century. I largely argued that there was good news and bad news, but that the improvements might be less impressive than is obvious, when you consider the hugely expanded variety and costs of anti-diabetes therapies over the same period.

An online medical publication called MedPage Today, in collaboration with the American Association of Clinical Endocrinologists, on 5/29/14, published an article titled, in part: “Complications of Diabetes Down? Not So Fast.”

In it the main author, David H. Newman, MD (who wrote the book “Hippocrates’ Shadow: Secrets From the House of Medicine”) argues that the improvements in diabetes complication rates, that even I acknowledged looked pretty impressive, were overblown. He correctly points out that not quite halfway through the study period the definition of diabetes was changed from a fasting glucose to 140 or above, to 126 or above. He persuasively posits that, effectively, overnight the number of diabetes patients increased, and that the added patients were all by definition milder cases of the disease. In other words the population of diabetics at most risk of complications was diluted by all those milder diabetics. Thus, there was a false lowering of, for example, the portion of diabetes patients suffering heart attacks, or having limbs amputated.

From this and other equally persuasive points (for example that higher quality trials have often not shown fewer deaths, heart attacks, strokes and so forth with glucose-lowering treatments), Dr. Newman concludes: “We should be proud of our public health accomplishments and particularly proud of any real improvements in outcomes for chronic conditions like diabetes. But if we delude ourselves into believing that failed, high-intensity, high-cost treatments are the reason then we are destined to repeat our failures instead of finding genuine solutions.

My take: drug therapies can often help improve diabetes control and reduce complications, but sometimes don’t or sometimes even may make things worse. Physicians are not maliciously complicitous with the pharmaceutical industry in some great moneygrubbing plot as certain wackos charge. But it is high time physicians and their diabetes and prediabetes and other at-risk patients accept the fact that the only real solution/cure for diabetes in many (not all) cases is massive lifestyle change—not small, but major diet changes, and changes in almost every aspect of life, and even society at large (much of which I discuss in my book “What About My Weight?”). I think these are the genuine solutions to which Dr. Newman alluded.

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