Effects of Intensive Glucose Lowering in Type 2 Diabetes

This study demonstrates what is likely the most profound mistake in research that occurs. There is a concept called “surrogate end markers.” The idea is that, for Disease X, patients with lower values of Blood marker B live longer or are less likely to get the disease. So, we create a drug that lowers Blood marker B synthetically, thinking that we will have an impact on Disease X. We don’t measure Disease X directly, because that would take too long.

The mistake here is that, what if Blood marker B being low and leading to lowered rates of Disease X is a reflection of the health of the patient, and NOT because Blood marker B itself is low? Time and time again we see that the use of surrogate end markers in research leads to WORSE outcomes when we artificial lower Blood marker B. The ACCORD trial here is no different.

Basically, in diabetics, we want HbA1C levels to be between 7 and 7.9%. In this large trial, the patients used aggressive insulin therapy to artificially drive that number down to below 6%. Sounds like a good thing, right? The trial was halted because there was a 22% increased risk of death in the intervention group. Now, we can bet that, with lifestyle changes lowering A1C levels to 6% that there would’ve been nothing but reduced death. Welcome to medical research.

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James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.