Aggressive Diabetes Therapy Lowers Death Risk, Study Finds

By Serena Gordon
HealthDay Reporter
Wednesday, February 6, 2008; 6:00 PM

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WEDNESDAY, Feb. 6 (HealthDay News) -- People with type 2 diabetes who are already showing signs of some kidney damage may be able to significantly lower their risk of death by treating multiple risk factors at once.

That's the conclusion of a new Danish study, published in the Feb. 7 issue of the New England Journal of Medicine, that found intensive therapy, including tight blood sugar control, low-dose aspirin, and cholesterol- and blood pressure-lowering medications when necessary, lowered the risk of all-cause mortality and cardiovascular death.

"The Steno-2 study shows a 20 percent absolute risk reduction in all-cause mortality in patients who originally were offered intensive therapy when compared with patients given the usual treatment," said the study's principal investigator, Dr. Oluf Pedersen, director at the Steno Diabetes Center in Copenhagen. "Similarly, the absolute risk for cardiovascular death was reduced by 12.5 percent in absolute terms."

The findings were published the same day that U.S. health officials announced a halt to a large diabetes trial because of high death rates among those receiving aggressive therapy. The study, involving more than 10,000 people, was dubbed the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial, and was stopped early on safety concerns after researchers found an increased risk of mortality in those whose blood sugar was aggressively managed.

Although the death rates in both treatment arms of the ACCORD trial were lower than is seen in the general population, 257 people who were on therapy to get their blood sugar levels in the non-diabetic range died versus 203 people receiving standard treatment.

"In the ACCORD trial we wanted to learn, does aggressive glucose lowering decrease the risk of cardiovascular disease? But, we found that in patients whose [blood sugar levels are] high, if we try to drive it to normal, there may be harm," said Dr. Hertzel Gerstein, a principal ACCORD investigator, and a professor of medicine at McMaster University in Hamilton, Ontario, Canada.