LOS ANGELES — It seemed like a good idea at the time. Diabetics are at an unusually high risk of heart disease, heart attacks and strokes, so treating them intensively to sharply reduce blood pressure, cholesterol levels and sugar levels should be highly beneficial.
A decade of studies in thousands of patients show that is not the case.
Two new reports from a major nationwide trial, released Sunday, show lowering either blood pressure or cholesterol levels below current guidelines does not provide additional benefit and, in fact, increases the risk of side effects. A third arm of the study, released two years ago, shows lowering blood sugar levels excessively actually increases the risk of heart disease.
The results are disappointing, researchers say, because they suggest clinicians may have reached the limit for what they can do for diabetic patients without developing new therapeutic approaches.
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But the good news is, the findings "reduce the cost and potential side effects of drug therapy" and mean patients will not have to work as hard at reducing blood sugars, lipids and blood pressure, said Denise Simons-Morton of the National Heart, Lung and Blood Institute, which funded the trial.
"The take-home message is that the standard care approaches are pretty good. If we try to go beyond them, it doesn't provide additional benefit."
Diabetes has become a problem in the United States, with at least 21 million people now afflicted with Type 2 diabetes — in which cells do not respond properly to insulin produced by the pancreas — and millions more at risk because of obesity.
Most diabetics also have high blood pressure and high cholesterol levels, which bring their risk of heart attack and stroke to the same level as that of people who already have suffered a heart attack.
Many doctors have reasoned that aggressively lowering blood pressure and lipids below nationally recommended levels might decrease the risk of heart disease, and the nationwide trial was created to study the possibility.
So what can patients do?
"My personal opinion is that we need to put more effort into prevention," said Simons-Morton. "If we prevent diabetes in the first place, we reduce risk. Once they have diabetes and risk factors, we are never going to treat down to a level of risk as if they never had diabetes."