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Time to Challenge Conventional Wisdom

Stephen Havas, MD, MPH, MS

Arch Intern Med. 2009;169(2):150-154.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The decision by the National Institutes of Health to discontinue the glucose-lowering portion of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial unexpectedly after 3.5 years because of an increased mortality rate in those randomized to intensive treatment of high blood glucose level led to numerous stories in the mass media noting how experts in the field were stunned by the findings.¹ Yet the results of this trial were predictable. For almost 40 years, there has been evidence that intensive lowering of glucose levels in patients with type 2 diabetes mellitus (DM) can lead to significant harm and has limited benefits. This raises the question of why so many clinicians neglected the accumulating evidence of harm and thereby got the issue of treating type 2 DM so wrong. This Commentary will seek to provide some answers to that question and to provide lessons . . . [Full Text of this Article]

THE WORKING HYPOTHESIS FOR MOST CLINICIANS


MAJOR RANDOMIZED CONTROLLED TRIALS IN TYPE 2 DM
Glucose-Lowering Trials

Lipid- and BP-Lowering Trials

RCTs IN TYPE 1 DM

THE BASIS FOR THE WORKING HYPOTHESIS

LESSONS LEARNED
Lesson 1

Lesson 2

Lesson 3

Lesson 4

RECOMMENDATIONS

ADDENDUM

AUTHOR INFORMATION


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