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Diabetes UK CEO urges diabetics to manage their cholesterol levels better, but is this advice based on good evidence?

Posted Sep 13 2012 9:19am

Baroness Barbara Young is the chief executive of the charity Diabetes UK, the UK’s largest and most prominent diabetes charity, and an organisation which encourages diabetics to eat at every meal foods which are known to be disruptive to blood sugar levels and therefore be bad for diabetics (go figure). You can read more about this here and here .

Baroness Young has been on somewhat of a media blitz recently, raising awareness of the ‘need’ for diabetics to have their cholesterol levels managed, including with drugs. Here’s a typical story on the BBC website, which includes this quote from the Baroness:

It will often be appropriate to prescribe medication such as statins, but it is no good doing this without explaining the importance of taking the medication regularly and the potentially devastating consequences of not doing so.

Baroness Young’s charity is not known for the evidence-based nature of its information and advice, and I decided to see if her urging diabetics to manage their cholesterol properly is scientifically supported.

I came across a pertinent review of this subject published earlier this year [1]. The authors of this review assessed studies in which cholesterol-lowering drugs were used in individuals with diabetes. They excluded studies which had been terminated early for no good reason (early stopping of studies is known to exaggerate the benefits and reduce the apparent harms of a treatment), and well as studies in which the participants were not properly ‘randomized’ (which effectively means that the underlying characteristics of those on the medication and placebo were not equivalent, which in turn can give misleading results).

Four trials were left: three in which a statin was the drug being tested [2-4] and one which tested the effects of a fibrate (another type of cholesterol-lowering drug) [5].

Here’s a brief summary of the results of each of these studies.

Study [2]: A reduction in risk of major cardiovascular events (e.g. heart attack or stroke) of 37 per cent but no reduced risk of death overall.

Study [3]: No reduced risk of a ‘composite endpoint’ encompassing a variety of outcomes including death from heart attack or stroke, non-fatal heart attack and stroke, and coronary artery bypass surgery. No reduced risk of death overall.

Study [4]: No reduced risk of a composite endpoint made up of cardiovascular death as well as non-fatal heart attacks and strokes. No reduced risk of death overall.

Study [5]: No reduced risk of fatal and non-fatal heart attacks. No reduced risk of death overall.

The authors of the review conclude:

This review does not support the use of cholesterol-lowering drugs (such as statin and fibrate) to reduce mortality and cardiovascular complications in type 2 diabetics.

The authors suggest that the guidelines regarding cholesterol management in diabetics have been corrupted somewhat by the conflicts of interest some advisors have by remarking:

Official guidelines should be re-examined and reformulated by experts independent from the pharmaceutical industry.

 

Sound like a good idea to me. And it reminded me that Diabetes UK has conflicts of interest of its own in the form of corporate sponsors in the form of drug and food companies. See here for a full list.

References:

1. de Lorgeril M, et al. Is the use of cholesterol-lowering drugs for the prevention of cardiovascular complications in type 2 diabetics evidence-based? A systematic review. Rev Recent Clin Trials 2012;7(2):150-7

2. Colhoun HM, et al; CARDS investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364(9435):685-96

3. Knopp RH, et al. Efficacy and safety of atorvastatin in the prevention of cardiovascular end points in subjects with type 2 diabetes: the Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in non-insulin-dependent diabetes mellitus (ASPEN). Diabetes Care. 2006;29(7):1478-85

4. Wanner C, et al, for the German Diabetes and Dialysis Study Group. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 2005; 353:238-248

5. Keech A, et al; FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005 Nov 26;366(9500):1849-61

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