Basic Foundation of Type 2 Diabetes Treatment Crumbles

In a startling development in Type 2 diabetes treatment, a wide held pillar of belief that aggressively keeping one measure of blood sugar (called HbA1c) below 6 instead of the standard 7.5 would reduce heart attacks and other cardiovascular events has crumbled. Businessweek has a very thorough article on this startling development.

How this will effect Sirtris Pharmaceutical’s SRT501 and NCE diabetes drug candidates cannot be known at this time. However, I find this excerpt from the Businessweek article particularly interesting:

"However, the evidence that aggressive blood sugar control using drugs brings benefits has always been weak. Proponents of more intensive drug treatment cite a landmark study started back in the 1970s called the U.K. Prospective Diabetes Study (UKPDS). In that trial, researchers followed thousands of patients with type 2 diabetes for more than a decade, comparing those who merely got advice on diet and lifestyle to those who took drugs to lower their blood sugar and keep it under tighter control. The researchers claimed the more aggressive treatment worked to reduce the complications of diabetes, which include kidney failure, blindness, amputation of infected limbs, and cardiovascular disease.

But in fact, the benefits seen in the trial were tiny or nonexistent. The study's authors had to torture the data to reach their conclusions, charges Dr. Robert Ewart, associate professor of family and community medicine at Southern Illinois University School of Medicine. "The UKPDS was a particularly egregious example of data manipulation," he says. "There just isn't any evidence that tight control of type 2 diabetes improves outcomes."

Ewart has plenty of company in doubting the trial. No oral diabetes drug "has ever been shown to do anything really good for any patient," adds Dr. Nortin Hadler, professor of medicine at the University of North Carolina at Chapel Hill. "No leg, eye, kidney, heart, or brain have ever been spared." And in a recent New England Journal of Medicine commentary, Dr. Clifford Rosen, chair of the Food & Drug Administration advisory committee that evaluated one such drug (GlaxoSmithKline's (GSK) Avandia), wrote that "the two largest randomized, placebo-controlled trials in patients with type 2 diabetes, the United Kingdom Prospective Diabetes Study and the University Group Diabetes Program, failed to find a significant reduction on cardiovascular events even with excellent glucose control.""

It is nearly impossible to come to any firm conclusions, with any level of certainty, that can interpret this new data. However, no one can argue that the best treatment for type 2 diabetes is what most humans seemingly don't want to hear: EAT LESS AND EXCERCISE MORE! In other words, live a healthy lifestyle. That is where it seems that targeting sirtuins may have advantages over other drug treatments. The basic premise behind sirtuin research is that the activation of certain sirtuins can mimic a calorie restriction diet (CRD). Long time readers on this blog understand that there are many studies that indicate that a CRD has been proven to increase longevity and fight off disease in many mammals (new readers should review early entries on the SI blog to learn about CRD). Could it be that mimicking a healthy diet may be the best way to treat Type 2 Diabetes for those who cannot live a healthy lifestyle on their own? Only time will tell. Interesting stuff.