THE ACCORD PROGRAM is in the headlines!!!!
 

Well, wouldn't you know it?? The ACCORD program (the protocol that I have been in for about 3 years (I'm in the standard group, not the intensive), well, it's in hot water.

People died, and for the life of me, I can't find exactly why when I read the article. I also received (via dispatch), a letter from the ACCORD people indicating that they are stopping the intensive program and moving everybody from the intensive program into the standard program. It doesn't involve anyone in the intensive blood pressure part of the program.

So someone read this and explain why the people died. By the way, I am not on any oral meds. Just the Lantus, which went from 46 units down to 26 (which I am now presently on)

Please?? I just got this off of my MSN homepage.

http://www.msnbc.msn.com/id/23029191

P.S. I am going there on Friday for my visit.

Mel

I could not really find a reason in the article why there were more deaths reported.

They stated they could not link it to Avandia or really to any major difference in that protocol, other than the more aggressive goal.

The above referenced article states only:

“A thorough review of the data shows that the medical treatment strategy of intensively reducing blood sugar below current clinical guidelines causes harm in these especially high-risk patients with type 2 diabetes,” said Dr. Elizabeth G. Nabel, director of the institute.

It was very vague. I am sure more articles will come out explaining it better.

I just finished a CE lesson on diabetes/goals.
 

What a coincidence.

It is not clear what is going on. Perhaps the cholesterol drugs were a factor, and just not mentioned in the article.

In this lesson is a reference to the EPIC-Norfolk study in Europe which suggested that A1c levels below 6 were a good target for death reduction.

It appears in the ACCORD study that the aggressive portion of glucose control was targeting that range. Typically in US the target is below 7, not 6.

I'll continue to look around...it might show up on PubMed, or a later article in more detail. NYTimes might do an in depth study, and expose more detail.

Diabetes drugs are not 100% innocuous either. Metformin can cause acidosis, and Avandia has shown some connection to death from heart disease. Diabetics have inflammatory vascular problems as well, which also might be a factor. I wonder if any of these people were tested for B12 levels, or other nutritional support? Obviously you Mel never were told to use B12 and you only do so because of this forum.

There were deaths in the HERS study on hormone replacement therapy, that study was ended early as well. Women were dying on estrogen. And developing dementia.

It looks like a complex situation. I predict there is not one clear answer to it.

Also, aggressive blood sugar control, can lead to hypoglycemia during the night. It would be interesting if these
subjects died at night. If blood glucose goes below 30 and the person is unconscious, they could easily die.

Holy Crap.

I keep taking my pulse. This darn thing scared the bejesus out of me.

I mean, give me a break. They put you in a protocol that is supposed to be saving lives, studying the affect diabetes has on the cardiovascular system, etc. etc.

I actually did better than I was supposed to. I got lower readings, my blood pressure is just fine, I went down on my meds. My a1c is better than the goal they set for me. They have no explanation, and as they put it "Melody, this is great for you, but not so good for the protocol you are in". We all had a good laugh (this was many months ago, because I go there usually every 2 months or so. And they give me a yearly BIG physical.

This friday is the BIG one!!! Marks the 2 year thing or something to that effect.

Thank goodness I wasn't in the intensive part of it. They told me "your body responded as if it were in the intensive part of the protocol, but you are actually in the Standard part".

I'll definitely ask some questions on Friday.

It ends in the spring of 2009. I mean, they are very good to me, take great care, (because I listened to every thing they told me to do), I took my meds faithfully and my sugar reading was better for it.

So how come 257 people died???

oh my!!

Mel, what is your A1c level?

Diabetics do die you know. They are not stable physiologically and have a shortened life span due to the damage the disease does to blood vessels.
This article did not clarify stroke -- thrombotic or hemorrhagic either.
So until the data is written up more clearly, it is hard to answer.

It is frightening to learn how much doctors don't know or understand. I wouldn't get all upset over this, since you appear to be doing well. If you were not so bad to start with, you may not have had the damage present already.
Some of those patients may have been really in poor shape.

another article:
 

from http://www.prnewswire.com/cgi-bin/st...4750723&EDATE=

It is a complex issue. The answer will take alot of time to be forthcoming, I predict.

Hi Mrs. D.

Oh, I forgot to mention that when I INITIALLY TRIED TO GET INTO THE STUDY, my a1c was 7 and I was turned down. It was explained to me that I needed an a1c of 7.5 to be admitted to the study.

Because I was self-medicating with food at the time, and not really doing a good job of managing my blood sugar, it was almost a year later when I went back and my a1c was 9.0. So they took me in the study.

When I went into the study, my sugar was 400 (because I shoveled snow). But it usually was 265 or so. I was on lots of metformin (which killed my stomach). Thank the lord I was able to stop the metformin. I stopped going to the bathroom 6 times in the morning. It didn't make me lose weight either. I had been on it for years before I got to the ACCORD program and I never lost any weight on Metformin.

So I joined the study, they put me in the standard group. I was also put on Vytorin but my muscles did NOT LIKE THIS MED, so I stopped after a few months.

I'm in the intensive blood pressure group (I think they only have an intensive blood pressure group). They tweaked my blood pressure meds because they believe a person who has diabetes is greater risk for stroke and heart attack so while a regular person might have 120/70, they REALLY LIKE WHEN MY PRESSURE IS 106/65.

They walk in and say "wow, look at those numbers"!!! I once said "isn't that low??" and they said: "are you kidding, your pressure is perfect".

I've never had a problem with my pressure since I've been going there.

They take it 3 times and then they average it out.

And I can refuse any thing I don't want to take.

But so far, I'm doing okay, so I thank god.

I have noticed that when I'm there, I see other diabetics getting their checkups. These are always woman and they are over 250 lbs. They are ALL on humolog, or novalog or some kind of insulin. Now I don't know if they are in the Accord Program like me, but they are always there.

I once read where you can be a type 2 and be on insulin (not like the Lantus that I'm on). But on the ones where you take a shot before you eat.

Lantus is not like that.

I still have goals. I'd like to be off all insulin. Hey, I'm 60 and I'm entitled to my goals. If I can do it, I'll do it. They seem to feel it's not such an impossible goal to achieve.

Time will Tell!!!

I know many Type 2's and they are on a lot more meds than I am on, plus they are on Cholesterol meds, and oral meds, and high blood pressure meds (I know some people who take 2 or 3 blood pressure meds a day.

I have a 63 year old neighbor who is on 11 pills a day (3 of which are high blood pressure meds), She's on 3 different oral diabetes meds, and her sugar reading is always over 200. ALWAYS!! The other day it was 265.
Then it got down to 175 and she called me and said 'My sugar is really good now, it's 175". and I just said "why on earth do you consider 175 good"??

And she said: "well, you know me, I'm usually 265, so 175 is good for me". She is over 300 lbs and she could have gone to the Accord study with me but she didn't want to go into NYC.

You know what confuses me. The people on the Biggest Loser.

They go in there saying "I was borderline diabetic, or they say "I'm diabetic", then they lose all their weight and then they say "I"m no longer diabetic".

Hey, I lost TONS OF WEIGHT. How come I'm still diabetic??.

Guess I'm too old at 60, huh???

Forgot to mention, at my last blood work, my a1c was 6.5

Insulin is given two ways...
 

a long acting maintenance dose like Lantus.

And some people need a bolus with meals. These people have to count carbs,
so they can inject the correct amount.

Some people need both, and others don't.

Some people are very brittle and hard to control. I used to work with a nurse and supervisor who were younger than me, with type II who had to use the insulin pump.

There are many variations to controlling Type II. Many type II people can be controlled well, with diet and exercise, if they are good at compliance.

Good at Compliance??? I'm so good at compliance that I think it's a bonus if I get to eat half an orange. That's a treat for me.

Oh, you asked if the people at Accord cared if I was on B-12.

Not only do they NOT care. When I mentioned that my feet seemed to be better in the burning aspect of my neuropathy, it was mentioned "this has more to do with your good glucose control than the fact that you are on B-12'.

So you can FORGET B-12 as far as physicians are concerned.

As a matter of fact, the only physician who was actually interested in hearing more about B-12 Methyl, was the neurologist who came to one of the Neuropathy Support Group meetings.

She said "I would never NOT be interested in anything anyone has to say about how they deal with their neuropathy. We learn new stuff every day"!!!

And this was a young woman who was specializing in Neuropathy.

She has been (to my knowledge) the only physician I have ever spoken to about Methyl B-12, and believe me there have been plenty, she's the only one who actually LISTENED.

Everybody else either said "I don't believe it" one guy actually said "it's only for Anemia, and I WOULD NEVER PRESCRIBE B-12 FOR NERVE DAMAGE". He actually said that.

Mind boggling.

How can physicians not LEARN as they PRACTICE. I mean, we learn new stuff every day.