A Dilemma for Diabetes Patients: How Low to Push Blood Sugar, and How to Do It?
Heart disease is the leading cause of death for people with Type 2 diabetes. Surely, then, the way to dodge this bullet is to treat the disease and lower blood sugar.
Well, maybe. Growing evidence suggests that the method by which blood sugar is lowered may make a big difference in heart risk. That has raised a medical dilemma affecting tens of millions of people with Type 2 diabetes — and for the doctors who treat them.
Some diabetes drugs lower blood sugar, yet somehow can increase the chances of heart attacks and strokes. Other medications have no effect on heart risk, while still others lower the odds of heart disease but may have other drawbacks, like high cost or side effects.
It’s becoming clear, researchers say, that there’s far too little evidence on how diabetes drugs affect the heart to make rational evidence-based judgments. “If you think the landscape is confusing, it really is,” said Dr. Leigh Simmons, an internist in Boston.
“Daunting” is how Dr. JoAnn Manson, the chief of preventive medicine at Brigham and Women’s Hospital, describes the situation for patients and their doctors. She explained the option and uncertainties in a recent commentary in JAMA.
There are 12 classes of drugs on the market and two or three different agents in each class. The drugs range in price from about $4 a month for older drugs to $700 a month for newer ones, and they have varying side effects. Many patients take more than one drug.
The older, cheaper and more popular diabetes drugs were never tested for their effects on the heart — they were approved before any Continue reading