June 20, 2012

Aggressive Glucose Control May Not Stop Kidney Failure

What is it about adding oral medication on top of oral medication that romances researchers to believe this is the only way to treat type 2 diabetes? In my reading over the last five years, it seems that unless researchers can have a cocktail of oral diabetes medications, the researchers are not interested.

I doubt I will find out, but it is interesting to speculate, especially after this from Yale School of Medicine. Here researchers discovered that aggressive glycemic control may not reduce risk of kidney failure. The researchers found that comparing usual treatment and controlling glucose with higher doses of medication did not improve the chances of preventing kidney failure.

Since the results are cloaked behind the veil of money, I am not able to determine what procedures were used and what combinations of medications, if any, were used. The write up about the research hides much information that could be of value. I will say this as I think it could be true also. The research did not reach the conclusion desired so they salvage something and explain the minimum to justify the study.

Since insulin is not mentioned or any other medication by name, it is difficult to give any reliability to this study. My interpretation is that this is again junk science and because the results were not what they wanted, we the patients learn nothing. If they had mentioned the medications by name and really tried to inform us, we may have learned which medications are useless for treating end-stage renal problems. I also have to believe that insulin was not part of the study and only oral medications were considered.

Since before the ACCORD study, stacking oral medications seems to be the only way to do studies. With the exception of Metformin which slows the release of glucose from the liver, oral medications work on the pancreas to produce more insulin and this means a quicker demise of the pancreas because it cannot continue to force out insulin as it is asked to do. Yet, this seems to be the only topic for research.

Therefore, I think it is time that studies are required to have a insulin control group to compare the results of oral medications against to see which gives the most efficient treatment. Then maybe the studies could have more meaning and give people with type 2 diabetes some actual comparisons for determining which treatment to use. Granted, some additional testing would be required of the pancreas before and after the study to determine the amount of insulin the pancreas is capable of producing.

This could also open new analysis for consideration as this is seldom mentioned in any of the current or recent studies. Who knows, we could have many study participants that are producing small amounts of insulin and incapable of more insulin production. This could produce misleading results for any study if these are the people participating in the study produce small amounts of insulin and the people in the control group can produce greater quantities of insulin. The reverse scenario would produce even more inflated results which the study wants. Yet this is something seldom seen even in studies given wide publication and not put behind a wall of money.

If it is the desire to prevent the general public from analyzing the study, then there needs to be a standard criteria published that will let the public know that these procedures were followed. Until this is done, we need to be skeptical of most studies and how much we should rely on their accuracy. Oral diabetes medications have their place and study under different scenarios is needed; however, a group within any study needs to be using insulin for a more accurate comparison.

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