GP advice - take medication (unnecessarily?)

[Peter C]

I think it's very unlikely that all T2's will be put straight on to metformin in the future in light of the ACCORD study which indicated increased mortality in the intensive therapy glucose lowering arm of the study (they're not sure why this occurred but it's from this study that the recommendation against intensive therapy to get HbA1c lower than 7.5% originated - it's important to note that we are talking intensive pharmaceutical therapy here, not intensive D&E).
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The initial analysis of the ACCORD study has been overturned on re-examination. The new analysis of ACCORD shows that for T2s getting your HbA1c as close to 6 as possible by any means ( including intensive medication) is the best option.
the re-examination focussed on what HbA1cs were actually achieved rather than on which arm of the study the subjects were in.
In the original study the T2s were divided in to two groups one aiming for A1cs under 6 ( none of the people attained that ) by intensive medication and the other going for A1cs over 7 with a relaxed regime. All had two or more risk factors for heart disease ( hypertension, dyslipidemia, smoking, obesirt(?)). In a normal population like that the normal death rate per thousand per year would be 35. The intensive medication regime got it down t0o 14 ( which would have been a great result to be trumpet around the world ) except that the relaxed group going for over 7 A1c got it down to 11 per 1000 p.a.
But Prof. Ruari Holman of UKPDS ( Britain's leading T2 expert) was first to question the knee jerk reaction which was don't go for A1cs under 7, dont go for intensive medicatiuon regimes; he pointed out there were still T2s in the alleged intensive arm scoring A1cs of 9 and 10, which shouldn't have been possible if they were having the kitchen sink thrown at them. It meant there was a real issue of compliance - people were SAYING they were sticking to the diet, doing the exercise recommended and popping all the pills and injecting the insulin when they weren't actually doing all that.
Holman asked for a re-analysis of the raw ACCORD data and the answer came back - getting your a1c as close to 6 by ANY means, including intensive medication, is the best policy for T2s and reduces the death rate to under the 11 scored by the better arm of the study.
So its back to intensive medication if you are at that stage and need it BUT you MUST actually stick to the regime.